Anthony Japour CW Decal Formm MIAMI BEACH
City of Miami Beach Board & Committee
City Wide Permit Application
DATE OF APPLICATION: ~~~o ~w ~
~-I- fI - '
LAST NAME: •J f~PU ~ ~- FIRST NAME: f~ ~~ l: N y
NAME OF BOARD/COMMITTEE: ~ ~ ~~ ~/y-~'-Gc.-l' ~~'1'f 3 ~ yn~/~f
ADDRESS: ' ~ ~ ~' S • ~U~ ~ ~~, ~ ~ ~ ~ ~
WORK PHONE: HOME PHONE:
VEHICLE MAKE VEHICLE MODEL VEHICLE YEAR TAG NUMBER
I understand that my Board/Committee City Wide Parking Decal entitles me to park
at any parking meter both on-street and off-street (metered parking lots) while engaging
in the business of the Board/Committee. I further understand that the City Wide Parking
Decal is NOT VALID at attended lots or garages-EXCEPTION: 17th Street Garage.
understand that if the parking decal issued to me is lost and/or stolen, it will not be
replaced until the next renewal period (no exceptions).
Applicant's Signature:
Decal Number Date Issued Expiration Date Parking Director's
Initials
ISSUED BY: DATE:
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