PERMIT DOCUMENTS A ,
o`�= 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 ' 02_32"
i
From: fl /c E y 5 am ac 'l ath e::S y /Iv` , (Contractor)
StA 4 7 6/ � uZ S R 4cLes.nc �
Kill'? 3 3 9- (Contractor's Address)
f I I ? P-I o Q4 cL (Owner/s Name)
�i I S-iJ • $ i - Ave ss Pc_ 33Y azt (Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
❑Certification of Window Installation
Certification of Door Installation
Other
)� (glass block, etc)
I, oe2-IC 31 . eq , am a licensed contractor (license No.
C?C�C r'Sn724J ) 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 ManJufacturer's Installation Instructions/NOA/ Product Approvals submitted.
�
Stfrfature of Qualifier Date
STATE OF FLORIDA, COUNTY OF PALM BEACH ���
The foregoing instrument was acknowledged before me this f ;5 /sr// ljtlate) by -C - _7ttt rLt ) , who
is personally known to me or who has produced �� //(type of identification)as identification
and who did (did not)take an oath. __�/�%i'%L�/'`�� C�✓( y
Signature of person taking acknowledgement 1, ;rfc.•; MATTHEW T REED
MY COMMISSION p GG054996
Name of officer taking acknowledgement--typed, printed or stamped '�3 EXPIRES December 13,2020
Title or rank Serial number
100 East Boynton Beach Blvd,PO Box 310, Boynton Beach FL 33425-0310 Phone:(561)7424350 Fax:(561)742-6357
S;IDevelopmentBBUILDINGIForms-Templates-Signs1Window end Door Affidevit.doc(11/11)