PERMIT DOCUMENTS ckit
40
' 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 33425-0310
Re: Permit No. 17-2532
From: RC Cole Construction Inc (Contractor)
3694 23rd AVE S#9 Lake Worth, FL 33461 (Contractor's Address)
Robert C. Cole (Owner/s Name)
2709 SW 8th ST Boynton Beach, FL 33435 (Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
❑■Certification of Window Installation
Certification of Door Installation
❑Other (glass block, etc)
Robert C. Cole , am a licensed contractor (license No.
CGC059747 ) 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 Manufa er's Installation Instructions/NOA/ Product Approvals submitted.
i // )/-7
• re •f Qualifier
Date
fTATE OF FLORIDA, COUNTY OF PALM BEACH � I 1 „ h
The • . • ,• • strument was acknowledged before me this^ ��1 (date) b � J-P r , who
is •- • • to me or who has produced (type of identification)as identification
and who di. cid not)take an oath. _ A L
Signature of person taking acknowledgement ` I ' ' r"4t SHANNON A.LOCKWOOD
�, - NdM Pe01k:-Stale of Florida
Name of officer taking acknowledgement--typed, printed or stamped ", 1-it,' Commission•al
`•• My Comm.ExpiresFF 593750
Title or rank Serial number one' Jun 10.2020
60nded ihmeSn knionsi Naas Assn.
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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