HomeMy WebLinkAboutPPP Compliance Affidavit[DU_NIVEV__IAL6
ENGINEERING SCIENCES
DR Horton-Creekside
Eastham N4odel-Lot 120
9520 Potomac Drive
FortPierce, FL
Private Provider .
p..
Plan Com fiance Affidavit
Eastham Model-9520 Potomac Drive
Private Provider Firm: .Universal Engineering Sciences..
Private Provider: John Carl Peterson
Address: 607 NW Commodity:Cove,-Port St.: Lucie, Florida 34986
Phone: 772-924-3575 Fax .772-924=3580:
Email: it etergon(a universalengineering.com
I hereby. certify that to the best of my knowledge .and belief the plans submitted "were:'.'
reviewed. for. and are: in compliance with the Florida Building :Code 'and :all local:
amendments . to. the. Florida' Building Code by the following affiant, who is duly
authorized to perform plans review pursuant-: to Section 553.791, Florida. Statute. and. -
holds the appropriate license_ or. certificate:
Name: John' Carl -Peterson Revised Plan-Sheets::.C-1,.GN,.A1; A2A; *El,.P1 .M1,.D1, D2,
WAL WAI.WA3.: WA4. WA6. S1. SI:IA. 'S1:1B, S1.2,-S-1.2A. SI S2AA, S2.2A,. S3.
S3.IA, S3.lB, .SN1
Florida License/Registration/Certification #(s) and description:.. .
John: Carl Peterson:
RPX 243
Signature of Reviewer: -
J
SWORN AND SUBSCRIBEI6
.. .
b fore me by John Carl Peterson, BU 1721
beingpersonally known to me
p Y
or Navin roduced.as.-idenhfication -.
gp
..
:.
and who being fully sworn. and .cautioned,'state
that the foregoing is -true and correct to the best of his/her. knowledge or.belief.
Sri
ignature o o
Print Name
Notary Publ' OTARY STAMP BELOW
My commission expires:
BRITTANY LINN J02A: '
/ �� / ' C
p� t.J p(J
Notary Public - State of - c' z. 4
�= d •<' Commission
t?!•c�d.�'' My Comin..Exp'ves Me• .:.
Natiera. %c.----
fJ,
9e through
.,d y