PERMIT DOCUMENTS -�
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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 33425-03101
Re: Permit No. 11 -217 6
From: parerchsc. EX /icrf (Contractor)
/1/b' G..fer,/t Drive; $6 (Contractor's Address)
1,0.115 Wes•./
(Owner/s Name)
6,5-0 Na-
{5� laGe (Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
nCertification of Window Installation
Certification of Door Installation
Other
(glass block, etc)
ban)la1 Rue7 , am a licensed contractor (license No.
Sc. (3t(So972. ) 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.
Signature of Q lifier Date
STATE OF FLORIDA, COUNTY OF PALM BEACH •
The foregoing instrument was acknowledged before me this (date) by , who
is personally known to me or who has produced
(type of identification)as identification
and who did (did not)take an oath.
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Signature of person taking acknowledgement ��
Name of officer taking acknowledgement--typed, printed or stam ed 91S •.•00 • f ...
P rr ��✓ CO,y••.B�.s;
Title or rank ' y
Serial number m :4�� .x ,
CM' mz
'•U�9c? Nolt
100 East Boynton Beach Blvd, PO Box 310,Boynton Beach FL 33425-0310 Phone:(561)742-6350 Fax: (561)742-6357
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