PERMIT DOCUMENTS 0
Acit City of Boynton Beach
om 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. 1700001428
From: ARMSTRONG BUILDING CONTRACTORS (Contractor)
975 S. CONGRESS AVE SUITE 102 DELRAY BEACH, FL 33445 (Contractor's Address)
PAPE RESIDENCE (Owner/s Name) •
2715 SW 4TH ST BOYNTON BEACH, FL 33435 (Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
*Certification of Window Installation
Certification of Door Installation
Other (glass block, etc) •
ABDIEL LOPEZ , am a licensed contractor (license No.
c6c1251234 ) 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/MCA/ Product Approvals submitted.
6/19/2017
Signature of Qualifier Date
STATE OF FLORIDA, COUNTY OF PALM BEACH
The f. •8'1•' iment was acknowledged before me this 19 (date) by JUNE 2017 , who
N personally knower. me or who has produced type of identification)as identification
and w o •I. did not)take an oath. �41 (SEAL)
Signature of person taking acknowledgement CO
Name of officer taking acknowledgement—typed, printed or stamped CHRISTINA PRITCHARD CHRISTINA PRITCHARD
Title or rank e°�\\\S MY COMMISSION#FF226744
Serial number
EXPIRES:MAY 04,2019
u101 Boned through 1st State Insurance
100 East Boynton Beach Blvd,PO Box 310,Boynton Beach FL 33425-0310 Phone: (561)742-6350 Fax: (561)742-6357
S:1DevelopmentIBUlLDINGIForms-Templates-Signslwindow and Door ARdavit.doc(11/11)