PERMIT DOCUMENTS •
•
frg
kii City of Boynton Beach
oN ° 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. 17-1562
From: Florida Home Improvement Associates (Contractor)
3044 SW 42 Street Hollywood, FL 33312 (Contractor's Address)
Stowell (Owner/s Name)
2009 SW 18th Drive (Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
❑■Certification of Window Installation
Certification of Door Installation
Other (glass block, etc)
Wayne Thomas Burnett , am a licensed contractor (license No.
CGC061690 ) 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.
S a re c Qua iffier Date
STATE OF FLORIDA, COUNTY OF PALM BEACH
The foregoin instrument was acknowledged before me this S(17_ fl (date) by Wayne Thomas Burnett , who
isersonally know tome or who has produced (type of identification) as identification
and a7ho-did&(d' not)take an oath. (SEAL)
Signature of person taking acknowledgemek>t .„... JANETTE L LUNN
Name of officer taking acknowledgement—typed, pjnted or stam d MY COMMISSION#G0032995
Title or rank Serial number v� EXPIRES August 07,2020
100 East Boynton Beach Blvd,PO Box 310,Boynton Beach FL 33425-0310 Phone:(561)742-6350 Fax:(561)742-6357
S:IDevelopment'BUILDINGIFonns-Templates-SignstWindow and Door Affidavit.doc(11/11)