PERMIT DOCUMENTS calk City of Boynton Beach
„ ° Building Division
LICENSED ROOFING CONTRACTOR
•
AFFIDAVIT
ROOF METAL & ROOF SHEATHING INSTALLATION
(EXISTING DETACHED ONE & TWO FAMILY DWELLINGS ONLY)
The City of Boynton Beach offers progressive inspections— 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 No. I(p oo no I (1(c5
From: S K Quo L4'4y 7R Ckino Inc (Contractor)
7(�) SIN / I 1 ,w , yeI/„( -111...d, .. irL 33yyL( (Contractor's Address)
( � -4 rno rn_ (Owner/s Name)
3 1O cf)ti n'Ir`,r Ln rP / On- t Yi (Property Address)
CMRTIFICATION SELECTION: (Please check all that apply)
Certification of roof metal installation, flashing, underlayment.
Certification of re-nailing roof sheathing, and removal and replacement of damaged or rotted wood.
Other RRoOtrin prvnrte.l.
r
I, r. I. boetd ((t..nye. am certified as a roofing contractor (License No.
('cc 1'3 '3.9 s°l i') ) and do hereby certify that all roof work (as indicated above) has been performed
at the above address in accordance with Chapter 15 of the Florida Building Code, Existing Building, as
amended, and Manufacturer's Specifications. I understand that the City of Boynton Beach offers progressive
re-roof ink.-,gimps. I hav- r• ified the owner of the property of this affidavit.
at� 3�z(7/GG
Sign)%f Qualifier— Date
STATE OF__FLORIDA, COUNTY OF PALM BEACH /
The foregoing instrument was acknowledged before me this / 1 /6 (date)by rI 1 t rip CO as ,who
is personally known to me or who has produced (type of identification) as identification
and who did(did not)take an oath. . (SEAL)
Signature of person taking acknowledgement ./411k - 2J4,L
Name of officer taking acknowledgement--typed, printed or stamp Ink /J'r C. pi,1,6 •
Title or rank Serial number c* WALTER C.LEWIS
( ,�' Notary Public-Sof Floridat q Commission 0 FFtate 962514
. ad+ My Comm.Ergres Jun 8,2020
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100 East Boynton Beach Blvd, PO Box 310, Boynton Beach FL 33425-0310 Phone: (5611194r-ontr tattoo inrat-war — '
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