PERMIT DOCUMENTS .\ , . . .
ArIrtr
. City of Boynton Beach .iBuilding Division
' INSTALLATION AFFIDAVIT
WINDOW & DOOR (replacement)
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. / -I- I 1 I M N
From: PMLrc.Y/S (Contractor)
Re , Q o o t(7( 8 B 33 Y2C (Contractor's Address)
MAIL* tcf CP-& (Owner/s Name)
707 Pis) /541— Sr no 23f-/,2 (Property Address)
CERT FICATION SELECTION: (Please check all that apply)
mortification of Window Installation
❑Certification of Door Installation
❑Other (glass block; etc)
I, i&Qfl k g 'r' I/ - am a licensed contractor„ (license No.
I ) and do hereby certify that all work (as indicated above) has been.performed and
installed at the above address in accordance with the 2007 Florida Building Code, Existing Building, as
amended, and Manufacturer's Installation Instructions/NOA/ Product Approvals submitted.
,ere7/21//1
' ignature of • alifier - Date
STATEOFFLORIDA, COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this?/t 7/1 ti (date) by cC j_ frir9 , who
is personall kno _who.has produced (type of identification)as identification
and who did (did not)take an oath. (SEAL)
/ P
Signature of person taking acknowledgement /P `�, M COMMISSION
R®
t'MYCONMISSIONeEEB63927
Name of officer taking acknowledgement—typed, printed or stamped EXPIRES:December 4,2016
Title or rank Serial number prem - eade4neeeetambar)Se .
100 East Boynton Beach Blvd, PO Box 310,Boynton Beach FL 33425-0310 Phone: (561)742-6350 Fax:(561)742-6357
S:IDevelopmennBU1LDINGFForms-Templates-SlgnslWlndow and Door Alfldavif.doc(11/11)