PERMIT DOCUMENTS •
L,• O,.
City of Boynton Beach
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. 14-2991
From: The Screen Depot, Inc. - (Contractor) •
1500 SW 30th Ave Suite It 15 Boynton Beach, FL 33426 (Contractor's Address)
Shirley Gatto (Owner/s Name) •
300 NE 26th Ave Unit N 114 Boynton Beach, FL 33435 (Property Address)
•
CERTIFICATION SELECTION: (Please check all that apply)
®Certification of Window Installation
[]Certcation of Door Installation
DOther • (glass block, etc)
I, Kenneth Miller am a licensed contractor (license No.
U-20748 ) and do hereby certify that all work (as indicated above) has been performed and
installed at the • •ve add -ss in accordance with the Florida Building Code, Existing Building, as amended,
and Manufa or's Ins .1 on Instructions/NON Product Approvals submitted.
// � /
.�, I,%/%//I,iu - July 22, 2014
gnaWre .f Aualifi" Date
•
STATE OF FLORIDA, COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this Judy Fogel (date)by Kenneth Miller ,who
is personally known to me or who has produced (type of identification)as identification
and who did (did not)take an oath. //� (SEAL)
Signature of person taking acknowledgement / �i7/7- �/ Tw1Yr L MILLER
Name of officer taking acknowledgement—typed, printe r stamped (�,C i—�;, y Public-Sits al Rona
�6, • eptxant.Nam MX/e.zoic
Title or rank Serial umber t:a 4 if 197240
J`':i INStlrauenui 'asy ann.
100 East Boynton Beach Blvd,PO Box 310,Boynton Beach FL 33425-0310 Phone:(561)7424350 Fax:(561)7424957
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