PERMIT DOCUMENTS •
•
to- City of Boynton Beach
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. j 7' d D 4 1 '
From: -rrect 3uff' CbA6 i auswo
rt1Cse... ��� (Contractor)
qq b ?Aye
1uFi A� ar '(Contractor's Address)
GAge ��"(Owner/s Name)
06
i s s tan ' C llgrroperty Address)
CERTIFICATION SELECTION: (Please check all that apply)
Certification of Window Installation
OCertification of Door Installation
QOther
(glass block, etc)
, am a licensed license No.
and do hereby certify that all work (as indicated above) has contractorbeenperformed 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.
e a ure o Qualifier
Date
STATE OF FLORIDA, COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this /re'
(date) by it-A O 11 who
is personally known to me or who has produced Ft ow J b ;�.s ! • w
u
and who did(did not)take an oath. `(type of identification)as identification
Signature of person taking acknowledgement . ' -- _ e/ (SEAL)
Name of officer taking acknowledgement—typed, printed or r mped
Title or rank1�Ai ww,d 1 Bund l B
Serial number
• •
r lig "'•., MARK J EASTON•
t
y' i• Commission a FF 915137
100 East Boynton Beach Blvd,PO Box 310,Boynton Beach FL 33425-0310 Phone: My Comm.Expires Sep 1,2019 l
• ,�, • ,�n Natlmal Not Assn. 1
S:IDeve1opmentIBUILD/NGIForms•Temp1ates-SignsIVldndow and Odor Adidavit.doe(11/11)