PERMIT DOCUMENTS f - 2221
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City of Boynton Beach
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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.
From: BNT Services, INC. (Contractor)
5302 NW 64th Way Coral Springs, FL (Contractor's Address)
Alexandria Hockeborn (Owner/s Name)
512 SE 26th Ave Boynton Beach, FL 33435 (Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
■Certification of Window Installation
Certification of Door Installation
nOther (glass block, etc)
-Rom RoM'S Z+fcA-lr_Q , am a licensed contractor (license No.
SCt31t5US4 ) 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.
Signatu7--
of Qualifier Date
STATE OF FLORIDA, COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this tr(14 tin (date) by 01.°444C lest"; who
i ersonally'known tom or who has produced (type of identification)as identification
and who did (did not)take an oath. /f Q (SEAL)
Signature of person taking acknowledgement � ___ ALEXANDER NUTNN
Name of officer taking acknowledgement--typed, printed or stamped AiLsOlvtAr 4€11As, �‘1421111
�✓ w�^ MY COMMISSION gff935395
Title or rank Serial number 6.d'S F>�RES. 1st tt 2079
Untied NroupA 1st State Insolence
100 East Boynton Beach Blvd, PO Box 310, Boynton Beach FL 33425-0310 Phone: (561)742-6350 Fax: (561)742-6357
S:IDevelopmentlBUILD/NGIForms-Templates-SignstWindow and Door Affidavit.doc(11/11)