140 NE 95 St (6)IIIIIBRINKS
HOME SECURI
TO WHOM IT MAY CONCERN:
I REQUEST TO CANCEL MY a.`OP PERMIT. THE PERMIT NUMBER IS 7- '& .
JOB ADDRESS: /ft 4/ 7f y • 'Oa/Ai/ i� like .3
NAME OF CONTRACTOR: P - /WM 76 je-e-
CONTRACTOR'S ADDRESS:.S71:_rN1/ /•5? 704---44— � / . //
THE PERMIT WAS ISSUED ON:
I REQUEST TO CANCEL THE PERMIT FOR THE FOLLOWING REASON:
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I AGREE TO HOLD THE CITY OF MIAMI, I ' AGENTS AND AUTHORIZED PERSONNEL,
HARMLESS AND RELIEVE THEM FROM ANY RESPONSIBILITY FOR DAMAGES, COSTS
OR EXPENSES, INCLUDING ATTORNEY'S FEE RESULTING FROM THE
CANCELLATION OF THE EXISTING PERMIT.
P SO E ESTING CANCELLATION:
DU G
R IN NAME)
(STATE OF FLORIDA)
(COUNTY OF DADE)
THE PERSON WHOSE SIGNATURE APPEARS ABOVE, DEPOSES AND :SAYS THAT
HE/SHE IS THE CONTRACTOR OR LEGAL OWNER OF THE ABOVE PROPERTY.
SWORN TO ND SUBSCRIBED TO FORE ME, THIS
OF Al( 77
MY COMMISSION EXPIRES:
Brink's Home Security, Inc. • 5765 N.W. 158th Street • Miami Lakes, FL 33014 305.558.6625
JULIO ROBLES
- ts: MY COMMISSION # CC 550034
June 4, 2
Rf,,tt
Ban d x Thru R otary Public Un ritere
CANCELLATION OF PERMIT
Affordable protection. A name you can trust
Affordable protection. A name you can ti ust •
NO PU:LIC
STATE OF FLOR IA AT LARGE
DAY