PERMIT DOCUMENTS o`r� 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. 16-0905 •
From: The Screen Depot,Inc. • (Contractor)
1499 SW 30th Ave.#9 Boynton Beach,FL 33426 (Contractors Address)
Beatrice Sperber . (Ownerls Name)
300 NE 26th Ave. Boynton Beach, FL 33435 (Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
®Certcation of Window Installation
['Certification 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 above address in accordance with the Florida Building Code, Existing Building, as amended,
and Manufacturers Installation Instructions/NON Product Approvals submitted.
/ 1
March 25,2016
()nature f!f Quaife Date
STATE OF FLORIDA, COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this March 25,2016 (date)by Kenneth Miller who
is personally known to me or%has-pnwfurael (type of identification)as identification
and who did (did not)take an oath. .. (SEAL)
Signature of person taking acknowledgem Th7► — a . RONNYJO aaLTcs '
Name of officer taking acknowledgement–typed, •rinted or ! wiped/Nlrt J��•)T c NOTARY PUBLIC
�—;'�- ' STATE OF FLORIDA
Title or rank Serial number _-,';+;ono FFI *cR
Expires 5)142018
100 East Boynton Beach Blvd,PO Box 310,Boynton Beach FL 33425-0310 Phone:(661)7424350 Far(561)7424397
S1Devebpmenf9UIWINGIFame•Ten SlgnsuMndowendDoorA/Adevltdoe(11/11)