PERMIT DOCUMENTS 0
AlitCity of Boynton Beach
Building Division
LICENSED ROOFING CONTRACTOR
AFFIDAVIT
ROOF METAL & ROOF SHEATHING INSTALLATION
(EXISTING DETACHED ONE & TWO FAMILY DWELLINGS ONLY)
The City of Boynton Beach offers progressive Inspections-call 742-6355
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. /�/ t 2 375'
From: Rnaclpr Rnnfing. Tnr (Contractor)
860 N. 8 St. , Ste 1 , Lantana, FL 33462 (Contractor'sAddress)
lC OHe r 4L VA-c6446" $i €N SCA.' (Owner/s Name)
1a V R .7)/2J✓E (Property Address) .
CERT ATION SELECTION: (Please check all that apply)
Ce cation of roof metal Installation,flashing,underlayment
U : • cation of re-nailing �thing,and removal and replacement of damaged or rotted wood.
r Other S/I7l4�P / T---Pia /Al /2la os-5t
I, ChristopherJJBossier , am certified as a roofing contractor (License No.
CCC 1 3 2 6 3 0 8 ) and do hereby certify that all roof work (as Indicated above) has been performed
at the above address in accordance with Chapter 15 of the Florida Building Code, Existing Building, as
amended, and Manufacturer's Specifications. I understand that the City of Boynton Beach offers progressive
re-roof in e ' . I h v .filowner of the property of this affidavit
F Pi -T L) 7011
Signa a l ler Date
STATE OF FLORIDA,COUNTY OF PALM BEACH L I
The foregoing instrument was acknowledged before me this-t th1 5 to+(date)by Christopher Boss of
is personally known to me or who has produced D (type of identification)as identification
and who did(did not)take an oath. (SEAL)
Signature of person taking acicnowtedgement rt -LL) /�
Name of officer taldng acknowledgement—typed,printed orstall/di An H i %
Ttdewrank Notary Public Serial number ANMARIE HIGGINS
My COMMISSION B EE195826
Nfir EXPIRES'.May 06.2016
I.:
100 East Boynton Beach Blvd,PO Box 310,Boynton Beach FL 33425-0310 Phone:(501)7424350 Fax:(581)7424357 -
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