PERMIT DOCUMENTS c^ O-
i City of Boynton Beach
°o . 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. //// Z
From: ‘v/7 mss,s, ‘N_:', few 411/7 (Contractor)
9,35I cW 80&R ,S// tAZ� y (Contractor's Address)
�v,C ' /340/?/%5 (Owner/s Name)
zogq sW k &ire, rYG`e "{ (Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
Certification of roof metal installation, flashing, underlayment.
Certification of re-nailing roof sheathing, and removal and replacement of damaged or rotted wood.
Other
I, Arn a.5 P , am certified as a roofing contractor (License No.
CCr 1 • • ) 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, - •• - • acturer' •ecifications. I understand that the City of Boynton eac offers progressive
re-r•• '>pecti• • . • o e• • - - • - o the property of this affidavit.
----Sea y, 20 //
ne Q.,:''!i ler Date
ST: - OF FLORIDA, COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this 'f/LOi/ (date) by t inn 0 �r\a.,c who
is personally known to me or who has produced DI (type of identification) as identification
and who did (did not)take an oath. LSEAL1
Signature of person taking acknowledgement ,"'"' �
JAVIER PEREZ
Name of officer taking'acnowledgenient—typed, printed or stamped , fill % N' Public-State of Florida 1
t ' I ) I.
7!^�11.,) Comm.Expires Jan 17,2018 I
Title or rank Serial number , ami; Commission IEE 160491 I
100 East Boynton Beach Blvd, PO Box 310, Boynton Beach FL 33425-0310 P o e: (5 N.)7424350 Fax: (561)742-6357
SADevelopmentlauilding1FormsBTemplates1RoofingMetalBSheathinglnsta11adonPolicy&Arfidevit-18
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