PERMIT DOCUMENTS 40 6-0 ist
c.'�n . I
a`.1 City of Boynton Beach
Building Division
LICENSED ROOFING CONTRACTOR
AFFIDAVIT
ROOF METAL & ROOF SHEATHING INSTALLATION
(EXISTING DETACHED ONE & TWO FAMILY DWELLINGS ONLY)
The City of Boynton Beach offers progressive inspections— call 742-6355
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 / 7 - Os 'f''_
From: GLJ S f-Zry l_ \ r.LO • (Contractor)
7 D 1) (2--1/4-s— et I 8 (Contractor's Address)
4-k(* 'A- c- kt-o'— (Ownerfs Name)
f Of v S tAi / Co S l (Property Address)
CER]]FICATION SELECTION: (Please check all that apply)
Cyctification of roof metal installation, flashing, underlayment
Certification of re-nailing roof sheathing, and removal and replacement of damaged or rotted wood.
z
• ❑Othl\\+*er p
I, ChQQ\ GU9c,,k%f\ , am certified as a roofing contractor (License No.
C. 0 nd do hereby certify that all roof work (as indicated above) has been performed
at the above addr-ss i. cordance with Chapter 15 of the Florida Building Code, Existing Building, as
amended nd i `nuf. , - ' -Specifications. I understand that the City of Boynton Beach off rs progressive
re-roof' •-•• ra notified the owner of the property of this affidavit
0 g i
S'.natur: of Qualifii r Date
STATE 0 LOR sA, COUNTY OF PALM BEACH ) ,
The foregoing instrument was acknowledged before me this Y t 7 �1
(date)by 1 hO\cic\ CANS\p (l • who
i personally known to me or who has produced (type of identification)as identification
--->
and w o I 01)take an oath l `'j (SEAL)
Signature of person taking acknowledgement —' _L
---'- -- Aaron Handler
Name of officer taking acknowledgement—typed, printed or stamped NOTARY PUBLIC
Title or rank Serial number _ STATE OF FLORIDA
1 t-
..."'"";,-,.
Came 00034342
'' '' Expires 1721/2021
100 East Boynton Beach Blvd, PO Box 310,Boynton Beach FL 33425-0310 Phone:(561)742-6360 Fax:(661)742-6357
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