PERMIT DOCUMENTS tit City of Boynton Beach
or ° 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
Re: Permit No. /7000 3067
AA From: IV\Mg- ( -ec4-f ProFik. (Contractor)
r551i W i 1-L6(3.1 tab i,U e6 ?Iwo (Contractor's Address)
+ LUCK (Owner/s Name)
176 S g XT—GT 134:3/ (Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
RfCCCry£eation of roof metal installation, flashing, underlayment.
certification of re-nailing roof sheathing, and removal and replacement of damaged or rotted wood.
❑Other erfuleigoerass
I1JWCc ( P , am certified as a roofing contractor (License No.
CC -t336I4 I ) and do hereby certify that all roof work (as indicated above) has been performed
at the ove address in accordance with Chapter 15 of the Florida Building Code, Existing Building, as
amen . iacturr s .ecifications. I understand that the City of Boynton Beach offers progressive
re-ro s ction, I hay. otifie. the owner of the property of this affidavit. /�Q/�
Sig ature of Oualifi;` I Date( /
STATE OF FLORIDA, COUNTY OF PALM BEACH �n ^ -L
oik , who
�
The for..' . instrument was acknowledged before me thisl–
fl4 I- I I (date) by
is .ersonally kno ' o me or who has produced /// (type of identification) as identification
an. : :': ( ��� `
ot)take an oath. / / / / - _ - - - (SEAL)
Signature of person taking acknowledgement `f - - ,• "io,„ CHARLENE OILLINGER
/' D �:�� '- ' Notary Public-State of Florida
Name of officer taking acknowledge e t-typed, printed or stamp- r,. %�rz=rte Commission I FF 967040
..//<.' s°,+ My Comm.Expires Apr 3.2020
Title or ran LLL T�-- Serial number .1 ;y4+�' Bonded through National Notary 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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