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APPROVED REVISION, R1 7-14-21 POWERS-R-SIGNATURE REPORT
Electronic Signature Report for Engineer of Record Project Name: ____________________________________________________ Project Address: ___________________________________________________ Project Description: ________________________________________________ Documents Submitted (Document name, Number of sheets, SHA Code): _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ __________________________________________________ Professional Engineer’s Signature / Seal ___________________________________________________ Professional Engineer’s Name ___________________________________________________ Professional Engineer’s License Number ___________________________________________________ Date ___________________________________________________ Firm’s Name and Certificate of Authorization No. (if applicable) //5$2''1 *$(5 560(1&6,(/ 67$7(2) 1R Powers Residence Pool 911 Jackson Way, Ft. Pierce, FL 34949 Pool Plans and Specifications, Revised Sheets 1 & 3 1. Pool Plans and Specifications, 3 Sheets, Revised Sheets 1 & 3 SHA-1:6C116F637EC131FD2746436E7566F5FC899C3A8D M. Randall Rodgers, P.E. 68212 12-16-2021