PERMIT DOCUMENTS ?SIC.O,, r . .
Alt City of Boynton Beach
�r°N ° 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,h, FL /33425-0310
Re: Permit No.
" ' I/-�l�p0
From: .no&C IJJf a�iC m (Contractor)
\� .5..c . at'N-�n u.-2 • (Contractor's Address)
Orly 13(a (A YI&O r4-11 1 • (Owner/s Name)
co(P U)h i Y"' 1 I Ants W oack (Property Address)
CIFICATION SELECTION: (Please check all that apply)
edification of roof metal installation, flashing, underlayment.
Certificatiqn of re-nailing roof sheathin and removal and replacement of damaged or rotted wood.
,/IOtherrhi oc(l'& 111s-t_QL°l- t Ito i ns/p.�-i•Nl S
1, �l()hArl ViUMe_G_1)-tH am certified as a roofing contractor (License No.
LI Q.CD 3 J1-17< ) and`do hereby certify that all roof work (as indicated above) has been performed
at the above address in accordance with Chapter 15 of the Florida Building Code, Existing Building, as
amended, and Manufacturer's Specifications. I understand that the City of Boynt n Beach offers progressive
of inspections. I have notified the owner of the property of this affidavit. s? 3/
a f u iffier` _,n Date
STATE OF FLORIDA, COUNTY OF PALM BEACH
The foregoing i n1 r`1en s acknowledged beforetm tis dck:4`\1(date) by\-) t' Y\U..`\.�(1�t1 �1^'�'i1 , who
is ersonally known to me or ho has produced\ 1\\ 111 (type of identification)as identification
and w id not)take oath. ." \� (SEAL)
Signature of person taking acknowledgement N. Q
-.� ,c;r.-. SYLVIA PECA .;
Name of officer taking acknowledgement—typed, printed ors ped L kNMerr Public•State m fl r '
Title or rank Serial number I t Cammiss1on•FF 95i9;'•
<� . • Mr Comm.Expires May 14,:
''4;I 4
Banded through NationNola' I.
100 East Boynton Beach Blvd, PO Box 310,Boynton Beach FL 334254310 Phone: (561)742-6350 Fax: (561)742-6357
S:IDevelopmentlBuilding1Forms&TemplalestRoofingMetal&SheathinglnstallalionPolicy&ANidavi!-1821amily(12/99,12/02,1/03,10/03,11/05,9/06, 04/09,
7/12)