PERMIT DOCUMENTS •
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o •
�t ll • q 2g City of Boynton Beach
ATONo�P 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. Iii 1-3(1
From: The Home Depot At Home Services (Contractor)
674 S.Military Trail Deerfield Beach,FL 33442 ( Contractor's Address)'
fkIA — ( Owner/s Name)
•
112M ).{&or-Vpre21* e4- - ( Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
l ertTcation of Window Installation
RC-edification of Door Installation
DOther (glass block, etc)
I, �o,�S,e [1i n C , am a licensed contractor (license No.
(rRPry-lt afl ) 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 Manufacturer's Installation Instructions/NOA/Product Approvals submitted.
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Signal re of Qualifier Date
• STATE OF FLORIDA,COUNTY OF PALM BEACH •
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• The foregoing instrument was acknowledged before me this 5/2740 (date)by (Iu/Cf[a. ,who
is personally known to me or who has produced • (type of identification)as identification
and who did(did not)lake an oath. (SEAL)
Signature of person taking acknowledgement Jk . -rney.S , WENDYL GRIFFIN
euc
Name of officer taking acknowledgement—typed, printed or stamped 1 STATE OF�FLDRIDA
Title or rank Serial number �• +" Cane*FF076008
• ' Expires 12/11/2017
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100 East Boynton Beach Blvd,PO Box 310,Boynton Beach FL 3 342 5-031 0 Phone:(561)742-6350 Fax:(561)742-6357
SlDevelopmenIBUILDINGIForms-Templa:esSignslNNMow and Door Affidevitdoc(11/11)