PERMIT DOCUMENTS City of Boynton Beach Building Division
LICENSED ROOFING CONTRACTOR
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AFFIDAVIT
ROOF METAL & ROOF SHEATHING INSTALLATION
(EXISTING DETACHED ONE &TWO FAMd DWELLINGS ONLY)
TO: City of Boynton Beach `
Department of Development—Building Division
Field Inspection Section
RE: Permit No. 17-2137
From: Christopher Bossier (Contractor)
613 Industrial St., Lake Worth, FL 33461 (Contractor's Address)
Patricia Simon &Jean Carlson (Owner/s Name)
1403 SW 17th Ave., Boynton Beach, FL 33426 (Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
Certification of roof metal installation, flashing, underlayment
dsertification of re-nailing roof sheathing, and removal and replacement of damaged or rotted wood.
Bother 'T;(e . r. IPro%ret% a H1- t-to1 'IroSsfe-SS
I, Christopher Bossier, am a certified roofing contractor(License No. CCC1326308) 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
Manufacturer's Specifications. I understand that the City of Boynton Beach offers progressive
re-r ections. I have notified the owner of the property of this affidavit.
g 12S1
Signature of Qualifier Date
STATE OF FLORIDA,COUNTY OF PALM BEACH �Q''� �vI
The forgoing instrument was acknowledged before me this Eft/44/19t=25t I (date)by
Christopher Bossier who is personally known to me or who has produced (type of
identification)and who did(did not)take an oath.
> �
Signature of person taking acknowledgement r
Name of officer taking acknowledgement—typed, printed or stamped
Title or rank Serial Number
+°'Frit,'. MONICA I BARRERAS
_� MY COMMISSION p GG088588
'•:,aYh�. EXPIRES February 01.2021