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PERMIT DOCUMENTS
tot City of Boynton Beach °P 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. /7-o•cx-,l1 From: /zik,,- / - - 4 19h1,�Cc, _x (Contractor) 6d/ l,v c&S ri / S� (Contractors Address) e/ CA r% (Owner/s Name) 7z-Al cliff/"id A El (Property Address) CERTIFICATION SELECTION: (Please check all that apply) mortification of roof metal installation, flashing, underlayment. ©Gertificatio=re- ailing roof sheathing, and removal and replacement of damaged or rotted wood. BOther Lypv /ofre/s4 I, pfor S/�-0 J� am certified as a roofing contractor (License No. ('C-c �3d9b1O ) 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 Manufacturers S•-c cations. I understand that the City of Boynton Beach offers progressive re i•- • -ctio . ave,= a owner of the property of this affidavit. Sign;./ofQualifier Date STATE OF FLORIDA, COUNTY OF PALM BEACH The foregoing instrument was acknowledged before me this 7 / /7 (date) by (IGA//Me,C., ,who is personally known to me or who has produced / (type'of identification) as identification and whoid not)take an oath. (SEAL) Signature of person taking acknowledgement fraee, Name of officer taking acknowledgement--typed, printed or s roped �`'""•°�% 1HOMs HOUSE MY COMMISSION d GG 00336E m Title or rank Serial number r I�xN EXPIRES:Ocober 16,2020 'rear��° Bonded TNN Budget Nepry Services 100 East Boynton Beach Blvd, PO Box 310,Boynton Beach FL 33425-0310 Phone: (561)742-6350 Fax: (561)742-6357 S:IDevelopmentlauilding%Forms&Templates%RoofingMetal&She athinglnstallarionPolcy&,4 fidavit-1BNemily(12/99,12/02,1/03,10/03,11/05,9106,04/09, 7/12)