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PERMIT DOCUMENTS 117 aS- 93 t' 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. 17cY3U9le31,3 From: Cv 6 Qat cre Av-t-a iti C (Contractor) 134 [4 % - ci'rti e-1-- k) lue6 FL 334) 1 (Contractor's Address) nkc. ooety MARKS (Owner/s Name) 1 9 3 Cf tRv S PRRt< C I ,Q (Property Address) CERTIFICATION SELECTION: (Please check all that apply) ❑ ertification of Window Installation ©Certification of Door Installation • ❑Other • (glass block, etc) I, ZIoj rrOcun S , am a licensed contractor (license No. 0 2a-$R 1 ) 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. 'Sighature of Qualifier 143Jfei Date STATE OF FLORIDA, COUNTY OF PALM BEACH The foregoing instrument was acknowledged before me this 7—/3-17 (date) by is personally known to me or who has produced �am��v'nt , won '�-- (type of identification)as identification and who did (did not) take an oath. Signature of person taking acknowledgement, /J (SEAL) Name of officer taking acknowledgement-typed, p ted or A\GELA}'ou:: Title or rank MY COMMISSION d FF 951052 Serial number u;3,1,:,,117,12,0.7 EXPIRES.A,,n'112020 'ea;F:tt Ecnd,c Mr,EJ get;J:Y-d SELY¢, 100 East Boynton Beach Blvd, PO Box 310, Boynton Beach FL 33425-0310 Phone: (561)742-6350 Fax: (561)742-6357 S:IDevelopmentlBUILDINGIForms-Templates-SignslWJndow and Door Afdavit.doc(11/11)