899 NE 92 St (15)NRCXE
1( m0000,
PROPERTY LOCATED AT:
As legal owner of subject property, I request the cancellation of permit number
issued to
for the following reason:
Date of last inspection:
Maga S'ine4fillafe
10050 NE 2 Ave
Miami Shores, Fl 33138
Phone 305 - 795 -2204; Fax 305-756-8972
www.miamishoresvillage.com
HOLD HARMLESS
Sq9 q 2 sr
e4itiae.e rr
hereby apply as owner - builder, or authorize (new contractor)
to apply for such permits as necessary to construct or complete the construction on subject property.
I agree to hold Miami Shores Village, its agents and authorized personnel harmless and relieve them from
any responsibility or liability for any legal action or damage, cost or expense (including attorney's fee)
resulting from the cancellation of the existing permit or the issuance of a new permit. I furthermore assume
responsibility for the correction, if required, of work performed under the permit for which I am requesting
cancellation.
(Owner's Signature)
(Print Name)
State of Florida
County of Dade:
The undersigned, being the first
property.
Sworn to and subscribed before me this
Notary Public, Sate of Florida at Large
:er
e Contr: ctor -Only if subcontractor
holds permit or if change of qualifier)
b4 ��
(Print Name)
IVJabe' v-
C ommission,) ;2319.
. L'xphies:Jiui ,3 2''S,
ii Bondcd 11 .
duly sworn, deposes and says that he /she is the legal 4 o ll'i t r tllie above
27 N0Udayof xX
J.W. A.B. MANAGEMENT CO
17275 COLLINS AVE.
SUNNY ISLES, FL
Miami Shores Building Dept.
10050 NE 2nd Ave.
Miami Shores, FL 33138
Attn: Claudio Grande, C. it .0.
Building Official/Director
Re: 899 NE 92" Street, Septic Permit
Please accept this letter as a Hold Harmless letter.
Please void existing permit by Miami -Dade Environmental Services, Inc.;
Qualifier- Jose Bolantos.
06 -20 -06
We hold the Village of Miami Shores harmless for the reissuing of the septic permit for
the above address.