PERMIT DOCUMENTS ,Di
c. City of Boynton Beach
Budding Division
INSTALLATION AFFIDAVIT • .
WINDOW & DOOR (replacement)
To: • City of Boynton•Beach, Florida
Departrnent of Development - Building Division
Field Inspection Section
100 East Boynton Beach Blvd., PO Box 310
•
Boynton Beach, FL 33425-0310 •
Re: Permit No. 114, —413 t
From: 1
S1 t 3 �t r4� 11d lam' La.- (Contractor) .
,, _.v y .► = t - Q - 'Asti-tractor's Address)
• �� ewen� (Owner/s Name)
- ,t i,, geAk , s, .y Property Address)
•
CERTIFICATION SELECTION: (Please check all that apply)
•
Certification of Window Installation
Certification of Door Installation
)Other (glass block, etc)
Pk*el lace 2 , am a licensed contractor (license No.
ricy c'ar" �:Zq�} ) and do hereby certify that all work (as indicated above) has been performed and
installed at the abdve address in accordance with the Florida Building Code, Existing Building, as amended,
and Manufacturers Installation Instructions/NON Produce Approvals submitted.
//���� %J3o /il
2 ature of Qualifier • Date
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STATE OF FLORID •, COUNTY OF PALM BEACH �/�y�� "to
gel Le 2 , who 1 ^
g/36 17. (date) by f'1
The foregoing in r mere was acknowledged before me this J
is personally known to me or who has produced ' • (type of identification) as identification
and who did (did not) take an oath. . - - ISBE ANGELBELLO
Signature of person taking acknowledgement ,. � • : Notary Public •Slate 01 Florida
Name of officer taking acknowledgement—typed����-�,�• d
Cc.nmission # FF 926156
Sen-I-number , My Comm-Expires Ott 11.2019
•
Idle or rank D ''- Bonded through Notional Notary Assn.!
•
100 East Baynton Beach Blvd, PO Box 310, Boynton Beach FL 53425-0310 Phone: (551)742-6350 Fu:(551)742-6357 -
__ --___,_-_ e___ner,...l-,.,n,,d nnnr Afidavf dx i11/1 i) r