PERMIT DOCUMENTS I
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�� 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. // &ba 313'
From: tiL-25T& 1:::-...74/1),/s /`L (Contractor)
/941 1 /nt1( a fa- b, (Contractor's Address)
q � few&
Vr2JL. 5 (Owner/s Name)�4lig 54) giic _ (Property Address)
CE13.TIFICATION SELECTION: (Please check all that apply)
t� ification of Window Installation
Certification of Door Installation
❑Other J, (glass block, etc)
I, bcu^i ./ / '4 g/” , am a licensed contractor (license No.
SCL -III so � ) 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.
I ' z �
Sign-ture of Quail -r Date
STATE OF FLORIDA, COUNTY OF PALM BEACH /I �
The foregoing instrument was acknowledged before me this IG to (date) by zDal °� ifler, who
is personally known to me or who has produced (type of identification)as '.-' ' :tion
and who did (did not)take an oath.
Signature of person taking acknowledge ,��� • 'i ti: HEATHER R�t
:: t:' • cOMMISS10N p cc008367
Name of officer taking acknowledgement--typed, printed or stamped EXPIRES June 27,2020
Title or rank Serial number 007177E-0153 �m.Na.
100 East Boynton Beach Blvd, PO Box 310,Boynton Beach FL 33425-0310 Phone:(561)742-6350 Fax:(561)742-6357
S:IDevelopmentlBUILDINGIForms-Templates-Signs1Window and Door Affidavit doc(11/11)