PERMIT DOCUMENTS ,
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t�'ct
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. 17-2688
From: The Screen Depot, Inc. (Contractor)
1499 SW 30th Ave. Suite#9 Boynton Beach, FL 33426 (Contractor's Address)
Clara Stohelake (Owner/s Name) '
1738 Palniland Drive Boynton Beach, FL 33426 (Property Address)
•
CERTIFICATION SELECTION: (Please check all that apply)
®Certification of Window Installation
[]Certcation of Door Installation
QOther (glass block, etc)
I, Kenneth Miller am a licensed contractor (license No.
U-20748 ) 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.
L 'll/` / • 7-C
Sig lure of Qualifier �:•=_/ /
STATE OF FLORIDA, COUNTY OF PALM BEACH nnII
The foregoing instrument was acknowledged before me this vll 1'S'7n11 (date)by Kenneth Miller who
is personally known to me or who has produced 11 a (type of identification)as identification
and who did (did not)take an oath. 0 (SEAL)
Signature of person taking acknowledgement Ia.4l _Nit ILA R JO PELTCS
1:1
NOTARY PUBIJC
Name of officer taking acknowledgement—typed, •rinte• •r stamped 1'- ,a)_STATEOFFLORIDA•
Title or rank Serial number -d ;'='.' Cenral FF123552
Expires 51142018
100 East Boynton Beach Blvd,PO Box 310,Boynton Beach FL 33425-0310 Phone:(561)7424350 Fax:(561)7424357
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