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PERMIT DOCUMENTS • Page 2 February 13, 2018 INSTALLATION AFFIDAVIT WINDOW & DOOR (replacement) s u a ' w t� m 0 14 4 OF BO r To: City of Boynton Beach, Florida Department of Development - Building Division Field Inspection Section 100 East Boynton Beach Blvd., PO Box 310 Boynton Beach, FL 33425-0310 Re: Permit No. 74 - 0660i/24 j 4LL0rJey From: • Scl5%vl pt' 19 Lei: _ i G,q //(Cont actor) (7g36 ?rifle/dolt reAv (3OGu, p /,$ (Contractors Address) Sake/7A t4w% (Owner/s Name) 7 ea m4 69P, Boiolin4 je,2iA-, It g,;1196. (Property Address) CERTIFICATI N SELECTION: (Please check all that apply) 72/Certification of Window Buck and Door Buck Installation ❑ Certification of Mull Tube Installation [' Other (glass block, etc) I, j) ;i1 70/9 , am a licensed contractor (license No. (Ge f SO4(ci, )and do hereby certify that all work(as indicated above) has been performed and installed at the above address in accordance with the Florida Building Code, Existing Building, as amended, and Manufacturer's Installation Instructions/NOA/Product Appo als submitted. Sfgn ture of Qualifier 144 ( Date • STATE OF FLORIDA, COUNTY OF PALM BEACH The foregoing inptrument was acknowledged before me this Cto, $. o9041 (date) by Sv&t t v'd Laivi , who is personally known to me or who has produced Cl... di_ (type of identification)as identifi• • • • r• take an oath. •, .• � • mm =-91ss,e Cmmri i Ti F�pires ri!p taN Signature of person taking acknowledgement •►,b (( % � fa,: �� ��,,, Name of officer taking acknowledgement—typed, printed or stampeu Title or rank Serial number it • 4 • I 0 - I + � 1 4.1 s `4 1 IL V I _err .r • 1. 1 , b �• ti n r r. i Y \• • ` •X \ ��� 4 • • E ,e 4: �, - L r ( , _ ,� 1 .�, ,, •, �, , ' I y //• ' • \ f A, ''i %l r I ' ' It Ilk ,.. i. / c. 1. J ! . F V .. + • e. ' ' Q *'. kg 10 .4....:.) 1 a A e \ i ! ,' . • 941 .al ..-1 I • 1 12•::L ,I.'1. 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