PERMIT DOCUMENTS 11) -
• `�sJ 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. 17-3075
From: The Screen Depot, Inc. (Contractor)
1499 SW 30th Ave.Suite#9 Boynton Beach, FL 33426 (Contractor's Address)
David Marks . (Owner/s Name) •
2620 NE 1st Court Apt#212 Boynton Beach, FL 33435 (Property Address)
CERTIFICATION SELECTION: (Please check all that apply)
®Certification of Window Installation
Certification of Door Installation
Other (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.
r�
Sig lure of Qualifier D 'e l
•
STATE OF FLORIDA, COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this 542. ?OI'i (date)by Kenneth Miller who
is personally known to me or who has produced (type of identification)as identification
and who did (did not)take an oath. Or)evn,
(SEAL)Signature of person taking acknowledge '. NONNYJOPELTCB
PeP
�� NOTARY PUBLIC
Name of officer taking acknowledgement-typed. .rinted or stamped Rann_j PeP�fs `..* . '-STATE OF FLORIDA
41a. • j COM FF123552
Title or rank . Serial number Pr 122-SC 2 Expires 511412018
100 East Boynton Beach Blvd, PO Box 310,Boynton Beach FL 33425-0310 Phone:(561)7424350 Fax:(561)7424357
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