PERMIT DOCUMENTS hr.is City of Soy_ nto . i Beach
Buildin Div
-- g si®n
LICENSED ROOFING -CO TRACTOR
AFFIDAVIT
ROOF METAL & ROOF SHEATHIN e. INSTALLATION
• (EXISTING ONE & TWO FAMILY DWELLINGS ONLY) -
The City of Boynton each offers progressive ins actions—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-NNo .
From: K. ;1; 115 .� , .. ` '�
/ ��I- t" 1� = i �.T1y ''II I Contractor) , , i
an 10a�a i (CohtractoAddress)
10 /mei,: (p3 b-xt- or._- (Owneds Name)
•
/ 70 S6.> /b'1r .
(Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
DCertification of roof metal installation,flashing; undertayment. •
EQCertification of re-nailing-roof sheathing, and removal and replacemer•t of damaged or rotted wood.
0ther ! - j(af.o.. r 51sc(r1
ertified
` I ` t Li. ' i and do hereby certify that alllll roof work (as ndicated abo ea) as been performed
at the above - rens • acc. dance .with Chapter 15 of the Florida. Building Code,•Existing Building, as
amended, an. Man u�r- Spe.� • .tions. I understand that the City of Boynton Beach offers progressive
re-roof inspe : I hai .'ifi4 a o i ner of the propertyofthis affidavit. .
Signature o f Qua i le 1
Date
STATE OF.FLORIDA, COUNTY OF PALM BEACH /
The foregoing instrument was acknowledged befor me this l" 2 `( ? (dat-)by (?,C L y.r p, A es-�
is personally known to me or who has produced who
e
and who did(did not)take an oath. n V n S (type of identification)as identification
Signature of person taking acknow ledgement �/-
Name of officer taking acknow ed ement—tygled,printed or stamped �'r'
:,�h11C - d;
Title or rank r
N bl {f'� I Serial number
MICHAEL G.CUNOIFF
.a' .'''r•- Notary Public•State o1 Florida
� _ Commission B FF 932313
_ - - tL , My Comm.ExDlresFe)2ary Assn.
100 East Boynton Beach Blvd PO Box 310,t�
o nton Beach FL 33425.0310 P`.. - ,. . -
SADevelopment1Building1Forms&TemplatesInooringMetal&Sheethinglnsta//ationPolicyBAKdavil-182 Ily(12/99,12/02,1/03,10/03,1505,9/06,04/09)