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<br />.. <br /> <br />(b) The agencies listed below have not'given ~ppt~v~l to <br />'the working drawings and speGifications for the reasons indicated <br />beneath their names. <br /> <br />,f <br /> <br />, , <br /> <br />Federal <br /> <br />~' <br /> <br />, Í.c?cal, <br /> <br />... <br /> <br />2.0 <br /> <br />3. <br /> <br />'4. <br /> <br />It is my opinion that the approvals from,the agencies listed above <br />~e (are not) necessary for the following reasons: (List agency <br />'according to'number above.)" " , ,: ' <br /> <br />" 1. <br /> <br />, , <br /> <br />2. <br /> <br />3. <br /> <br />, - 4. <br /> <br />"~ (c) I hereby certi~Y' that the agencies ~~ subparagraphs <br />:. ,(a) and (b), above constitute all of, the' agencies from which approval <br />.' 'must be obtained in order that the project can be 'completed in ac- <br />~~.~ ~ordance with the drawings and specifications and that such services, <br />-,' which are necessary for the operation of the project after completion <br />will be supplied. ' <br /> <br />. , :. 4. I hereby certify that I am duly authorized to execute this <br />. ,.document o'n behalf of' and to bind myself <br />anc1 the firm of , ' ,as, to the truth of the state-. <br />ments recited herein. . <br /> <br />:Any false statement made knowingly herein may subject the signer to <br />-civil penalties under Section 231 of Title 3~ of the united States <br />Code, and, if such statements are made ,.,il1ingly and knowingly, to <br />..conviction for a felony under Section 1010' of Title 18 o£ the United <br />States' Code. ' <br /> <br />" " " <br /> <br />.-",. <br />0; <br /> <br />(Date) <br /> <br />:' <br /> <br />, . <br /> <br />, (Archi. tect) <br />, personal1yand,f<?r <br /> <br />'../-'.' '""--' <br /> <br />. ' <br /> <br />" <br /> <br />I <br /> <br />'. <br /> <br />(Registr<:ttion NO.) <br />