PERMIT DOCUMENTS L\1Y Da
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 -0334250310
Re: Permit No. h 19- I 2-I .%
From: Window World of West Palm Beach (Contractor)
1500 N. Florida Mango Rd., Suite 16B, West Palm Beach, FL 33409 (Contractor's Address)
Kevin and Michelle Michalowicz (Owner/s Name)
608 SW 1st Avenue, Boynton Beach, FL 33426 (Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
■❑Certification of Window Installation
❑Certification of Door Installation
Other (glass block, etc)
l Mark Collins , am a licensed contractor (license No.
cBc1260052 ) 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 Manuf er's I II. ': uctions/NOA/Product Approvals submitted.
Il( -81110
ig ature of Qualifier Da e
STATE OF FLORIDA, COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this 04/2-9(t‘ (date)by Mar k-- Co(I i r S ,who
is personally known to me or who has produced pens cv1ra1U le—vlowin (type of identification)as identification
and who did (did not)take an oath. �� (SEAL)
Signature of person taking acknowledgement
Name of officer taking acknowledgement—typed, rated or stamp 0„"' PAULA J. LEBLANC
Title or rank r` O t"
Serial number w i f Notary 19 1$ I of. 4, 20
'��. .3.?3,:a'r My comm.M. l�pNel NOv, 1, 1014
Commission Number FF933BB6
•100 East Boynton Beach Blvd,PO Box 310,Boynton Beach FL 33425-0310 Phone: (561)742-6350 Fax: (561)742-6357
S:IDevelopment\BUILDINGIForms-Templates-Signslwindow and Door ARdavit.doc(11/11)