PERMIT DOCUMENTS - . 1
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City of Boynton Beach
rON0`` 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
sFromRe: Permit No. I70000d3 95-
From:
: Mark Collins,Window World of West Palm Beach (Contractor)
1500 North Florida Mango Road,Suite 168,West Palm Beach, FL 33409 (Contractors Address)
Nirva Nerve! (Owner/s Name)
315 SW 12th Avenue (Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
*Certification of Window Installation
nCertification of Door Installation
Other •1ruLLr0^-) /pol5. 1 (glass block, etc)
I, Mark Collins , am a licensed contractor (license No.
cec7260052 ) 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 M . .. r- s Installatio. • - ructions/NONProduct Approvals submitted.
7janoyc
—ar�, S/t-t ili
ig attire of Qua ifier Date
STATE OF FLORIDA, COUNTY OF PALM BEACH
The foregoing Instrument was acknowledged before me this 429/26/7 (date) by Mark Collins who
is personally known to me or who has produced -personally known to me- (type of identification)as identification
and who did (did not)take an oath. / / (SEAL)
Signature of person taking acknowledgement /l -� : alt /-�= •°„,,,, PAULA J
. LEBLANC
Name of officer taking acknowledgement–typed, printed or sta .ed Palcia- J. LeWa'iv z,,,,,,,,11: "No,Public.Slate of Florida
`'s' , ••17 corn.expires Nov, 4. 1019
Title or rank Serial number ss;r n.
�rcer FF 900686
100 East Boynton Beach Blvd,PO Box 310,Boynton Beach FL 33425-0310 Phone:(561)742-6350 Fax:(561)742.6357
S:IDevelopmentlaUILDINGIForms-Templates-SIgnslWlndow and Door ARdavit doc(77/71)