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PERMIT DOCUMENTS �,..r e. Nik 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. I I - 5(9 1 From: r--' 14:;t1/4 ti'.'. -0,r.fr caa_ -s owl r7 to i.. ) to, , 1., (Contractor) q? y er1l�K,-, J Aocc, it Jo tr., 43`tt (Contractor's Address) 1\6 b1L,., rgzt.-s•c (Owner/s Name) ( 331 N r•r,,,,,j,,.-i< M- iiti M '.,.. RL.2... l 4-4, (Property Address) CERTIFICATION SELECTION: (Please check all that apply) FIC rtification of Window Installation Redification of Door Installation Other (glass block, etc) I, 'rl1A,,, try,...,r r. , am a licensed contractor (license No. (5( 06eo5-y ) 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. (1 .1 - "C ©a- , /3 --- / Signature of Qualif r Date STATE OF FLORI A, COUNTY OF PALM BEACH +� l' The foregoing instrument was acknowledged before me this 13 ' (date) by 04-Ael s-' Zolfo, who is personally known to me or who has produced ti- J� (type of identification) - ntification and who did take an oath. ,/' (SEAL) Signature of person taking acknowledgement Name of officer taking acknowledgement--typed, printed or stamped A,�'u.% , Title or rank Serial number t ai x Hm,ryPublicD 0 SL Ny 1 Flo rida?a C0mm.Ickes Oct 29,2016 +o„;t.••• Commission•EE 216810 - 100 East Boynton Beach Blvd, PO Box 310, Boynton Beach FL 33425-0310 Phone:(561)742-6350 Fax: (561)742-6357 SlDevelopmentlBUILDINGIForms-Templates-Signs1Window and Door Affidavx.doc(11/11) • • YVA.111r1 0 6 r 111af �6: 6J11Gt1 In Oi612-nlldu9 Yie1nN V^ 2tOS 2C u0 oa iVe3.mmol 4M °;',a �.f nor.; 33 + nfO rrm:09 y