PERMIT DOCUMENTS �� City of Boynton Beach
HTo `
Building 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. /y- 00[00976tl
From: LT-�'eiime Es-leernn-S (wtac/Doo4e) (Contractor)
tool S. F St I-pie )d-4-4. , FL 33V60 (Contractor's Address)
OA\c SP CO b S (Owner/s Name)
/0630 Royal CakiAbea,u erg. .oy4a..) 33t/39(Property Address)
CERTIFICATION SELECTION: (Please check all that apply) •
Certification of Window Installation , t
81 Certification of Door Installation
Other (glass block, etc)
I, S+e e e m •eA-QS , am a licensed contractor (license No.
CI /7 '/37 ) 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 submitted.
•
Si ure of Qualifier
STATE OF FLORIDA, COUNTY OF PALM BEACHIA
�� "The foregoing instrument was acknowledged before me this I� "" i� '9 'date7te
y �t. a,i'Vcoa.rf ,who
is personally known to me or who has produced S(s atL1 I<k „x
� n (type of identification)as identification
and who did (did not)take an oath. v^ _ (SEAL)
Signature of person taking acknowledgement V — f Notary Public State of Florida
Name of officer taking acknowledgement–typed, printed or stamped 41". Deborah Pesilo
Title or rank Serial number (l Ex pommission EE anon
ar wP' Expires 09/1�I2011
100 East Boynton Beach Blvd,PO Box 310,Boynton Beach FL 33425-0310 Phone:(561)742-6350 Fax: (561)742-6357
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