PERMIT DOCUMENTS • 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. /7 9 32-1?
From: Soo-, /4js #t Kt S4 Rica ES (Contractor)
gcts.
4'?e if, riai►- "fes (Contractor's Address)
•
lever-dela A-'A ent (Owner/s Name)
7�!
W. )e .ra✓ Dae, (Property Address)
CERTIFICATION SELECTION: (Please check all that apply) •
Certification of Window Installation e
mortification of Door Installation
DOther (glass block, etc)
I, DEKA-C HALL-Ey , am a licensed contractor (license No. •
C GC. co 7Zf-/ ) 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.
•
ignature of Qualifier • Date
STATE OF FLORIDA, COUNTY OF PALM BEACH )
The-foregoing instrument was acknowledged before me this Intl-( 7(date) by pit ea ea7 , who
is personally known to me or who has produced (type of identification)as identification
and who did (did not)take an oath.
�174� (SEAL)
I41C/
Signature of person taking acknowledgement nr o
441-NMA17ftEWi.tiEED
Name of officer taking acknowledgement--typed, printed or stamped . c * MYCOMMISSION,EE853827
1-17% EXPIRES:December 4 2016
Title or rank Serial number 440.00 mi4.4%euaggxiwrservice
:
•
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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