PERMIT DOCUMENTS Alit City of Boynton Beach
"' 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, FL 33425-0310
7
Re: Permit No. �I"! — a-7a
From: ROO-kee, 9iethif0 /, n (Contractor)
J ) S.e-at 4-eat �[ cai / te/i (Contractor's Address)
�
�1)6rkY°l n &1'&MCQ-II � (Owner/s Name)
a2n i Su). 2vrlW GU (Property Address)
CERTIFICATION SELECTION: (Please check all that a ly)
ertification of roof metal installation, flashing, underlayment.
ertificati 97,of re-nailing roof sheath' g, and removal and replacement of damaged or rotted wood.
Other lL! !nS/u� (244-2/AA/
1 �/U U.iC� ((((////
,� � am certified as a roofing contractor (License No.
(!ee o,3; -73- ) arld 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
a - •ded, and Manufacturer's Specifications. I understand that the City of Boyn on Beach offers progressive
r=ele; g ions. have rotifieedthee er of the property of this affidavit. ���
• = uh� !-li ler 1 Date
STATE OF FLORIDA, COUNTY OF PALM B •CH A^ \p
The foregoing instrument was acknowledge. •efo - : t% , (date) b �,_\ A` PA\ , who
la-personally known to me or who has produce. `` (type of identification) as ide tification
and who did(did not)take an oath. gytyiA PECARO
,nu.Signature of person taking acknowledgement 7.11ek
; r \ sy Nopu0llc-State of Florida
Name of officer taking acknowledgement—typed, printed or stamped - -Ilk",
•t t•
• ConMtltsion I FF 957959
Title or rank Serial number `o k My Comm.Expires May 11,2020
it . Banded through National Notary Assn.
•
100 East Boynton Beach Blvd,PO Box 310,Boynton Beach FL 33425-0310 Phone: (561)7424350 Fax:(561)742-6357
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