PERMIT DOCUMENTS r'
4%v 05
City of Boynton Beach
403
_ ° 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. —
From: 13,4 (C,7 5 ouc St 2vittS, / Kee__ , (Contractor)
E 47 6 4-1.,_ es nc.14 3 3 9-ZS— (Contractor's Address)
SLR_ P f L /j�A- (Owner/s Name)
013 s•W• 13 ` W try IBB 33 y z 6 (Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
Certification of Window Installation
Certification of Door Installation
❑Ot(heer p (glass block, etc)
I, ^1/4 i g 4-' k7 , am a licensed contractor (license No.
('O099-'4( ) Land 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.
Jl
AO - � X-77 17—
ature of QualyP(er Date
STATE OF FLOR//DA, COUNTY OF PALM BEACHAVE'he foregoing instrument was acknowledged before me this (, 7411/417
ate) by'4,7-'r— /1✓ who
is personally known to me or w has produced (type of identification)aside ification
and who did (did not)take an oath. (SEAL)
Signature of person taking acknowledgement ce... I . - r.
ft, MATTHEW T REED
Name of officer taking acknowledgement--typed, printed or stamped MY COMMISSION It GG054996
Title or rank Serial number EXPIRES December 13,2020
100 East Boynton Beach Blvd, PO Box 310, Boynton Beach FL 33425-0310 Phone: (561)7424350 Fax: (561)742.6357
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