PERMIT DOCUMENTS • Page 2 February 13, 2018
INSTALLATION AFFIDAVIT
WINDOW & DOOR (replacement)
S
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. to - SZ 31
From: T IS G\t1"t- cc,Ns C J ►--C. , (Contractor)
1 -, 7 'S %Z jwrowac.ar 1/vatt-,-ctae.. V.1., (Contractor's Address)
Nkit. C-5 (—tn.,t t (Owner/s Name)
cztS wrt ,S tor- 1 Co--R..�,,\.. ?C 334-4<(Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
LIE Certification of Window Buck and Door Buck Installation
❑ Certification of Mull Tube Installation
❑ Other (glass block, etc)
I, 1 i rr. C--,‘VT-r-- , am a licensed contractor
(license No. GL o4oC Cc )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
Approvals submitt= .
_� Z lI / Z. )
Signature of Q '-fit Date
STATE OF FL•RIDA, COUNTY OF PALM BEACH
The foregoing instrument was acknowledged b- . - •• -chic i/ (date) by
Geb,-,.€a-47 , who is . .nail known to a or who has produced
take an oath. (type of i.en . '. . Lente Ica and who did (did not)
Signature of person taking acknowledgement
Name of officer taking acknowledgement—typed, printed or stamp d
Title or rank Serial number
I AOBEAi BAYAN WING I (f--,_e,.. - -7 J
� , Notary M,bik•State of Florida I
Canmia.lon. F bo,
I „m �� Aty Cantu.Esolres Feb t.20ts I
Bonded through National Notary Assn. I
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