Loading...
PERMIT DOCUMENTS r,TY f, A,,,rt , City of Boynton Beach 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 33426-00/3�10 Re: Permit No. /6 -3(6(X 1 From: AN1 LAM-vas 4, SO A) (Contractor) ii / f) N r Jo,b A-V t. (Contractors Address) D£'t-kA'y Zc ACAS (Owner's Name) /,:2e S (4r /041 Aut. (Property Address) CERTIFICATION SELECTION: (Please check all that apply) n o nt Willi VNG Soo f 'D T)Ts P(-Ilk ✓ mortification of re-nailingroof sheathing, and removal and re '-fn's fUarr ��� Ngo ru,rov a-Arll 9 pace nt o malted or rotted wood. [Other I N see-c-100 apo N LRS'ATI ( s (4t U6 (.,F.�i[Other I. 'on( IA ' W A R R/J am certified as a reefing contractor (License No. !6 c. /51i ao tv ) and do hereby certify that all roof work(as indicated above) has been performed at the above address in accordance with Chapter 16 of the Florida Building Code, Existing Building, es amended, and Manufacturer's Specifications. I understand that the City of Boynton ach offers progressive re-roof in I have notified the owner of the property of this affidavit. %Y Signs Q ails' O 3/ o� I Date STATE OF FLORIDA,COUNTY OF PALM BEACH /,/ The foregoing instrument was acknowledged before me this S/- //7 (date)by (1/24Y q 2iS who Is personally known to mo or who has produced (type of identification)as Identification and who did(did not)take an oath. (SEAL) Signature of person taking acknowledgement A i , �jJj 'ams o o"cer ta, g acknowledgement—typed,printed or stem.:.. _ s — - Title or rank ©n.ey Serial number I ... `\ toM�LrauxE NoW'PuhOc-9aYetFIMJa •i tomnisloni GGta7an S,, MycmimExsetrittrx¢i ••. aakd Moly Nl9oAMbyAmi, 100 East Boynton Beach Blvd,PO Box 310,Boynton Beach FL 334254310 Phone:(561)7424350 Fax:(561)742-6357 l0erelopmonliBuadinplFormadTemplatesw7ooRngMeteldSheaWnglnstaatbnPollcy6NFpevit-162famtly(12)80,12/42,1A3,1d03,11/05,906,04.09, /