(Sello y Firma)Municipalidad de: SURQUILLON de Expediente:1. SOLICITANTEINMOBILIRI !"ONS#RU"#OR""S IN$ES#MEN# S"%Ra&onSocial '()*)+,-(-,Domicilio :LIMLIM MIRFLORES.epartamento /ro0incia .i1trito$%ENRIQUE /L"IOS 2,+Ur3ani&aci4n 5 %66 5 OtroM&Lote Su37lote 0 5 8r 5 "alle 5 /a1a9e N: .pto%2. UBICACIN DEL TERRENOLIM LIM SURQUILLO.epartamento /ro0incia .i1tritoL "LER .E L MER"E. I *' BERNR.O6OUSS! *;2Ur3ani&aci4n 5 %66 5 OtroM&Lote Su37lote N: Int%3. PROYECTISTA O RESPONSABLE DE OBRAME#ROS URBNOS ! E.IFI"#ORIOS LI"EN"I .E OBR /R "ER".O "ER#IFI".O .E FINLI?"I@N .E OBR! .E ?ONIFI""I@N M/LI"I@N .E LI"EN"I .E OBR No% RE$LI."I@N .E LI"EN"I .E OBR No% M/LI"I@N .E /L?O .E E8E"U"I@N .E OBR INFORM SOBRE #RB8OS QUE NO REQUIEREN LI"EN"I (*):"ON.I"IONMIEN#O< N#E/RO!E"#O RQUI#E"#@NI"O EN "ONSUL# $RI"IONES .URN#E EL /RO"ESO .E OBR "MBIO .E /ROFESIONL RES/ONSBLE .E OBR O#RO (e1peciLLENRM>QUIN O "ON LE#R .E IM/REN# LOS .#OS NE"ESRIOS /R EL #R>MI#E QUE SE RELI? ! MR"R "ON < LO QUE "ORRES/ON.%LE 5 .NI 5 "I 5 "E 5 RU"0 5 8r 5 "alle 5 /a1a9eLE 5 .NI 5 "I 5 "EN: de ReAi1tro"/ 5 "I/FORMULARIO OFICIAL MLTIPLEFOMLEY N 27157MINISTERIO DE TRANSPORTES, COMUNICACIONES VIVIENDA Y CONSTRUCCIONrBuitectoInAeniero "i0ilInAeniero SanitarioInAeniero Electrici1taREF""ION(*) Incluir de1cripci4n de lo1 tra3a9o1 en ca1illero -5. IRMAS Y SELLOS EC!A: O, DIA OC MES '((C A"OrBuitecto 5 InAeniero /ropietarioD poderado o FIRM ! SELLO FIRMCON#OCATORIA DE DELE$ADOS AD%!OC Nom3reD Firma y Sello EC!A DE CON#OCATORIA:%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% RESOLUCION DE N&Nom3reD Firma y Sello EC!A DE EMISION: EC!A DE #ENCIMIENTO: OBSER#ACIONES :%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%Lo1 1u1crito1 a1umimo1 la re1pon1a3ilidad 1o3re la 0eracidad y exactitud de la inEormaci4n y documentaci4n Bue pre1entamo1D conciente1 de lo1 eEecto1 pre0i1to1 por la Ley para lo1 ca1o1 de Eraude o Eal1edad%'. INORMACIN COMPLEMENTARIA (USR "UN.O .ESEE "OM/LEMEN#R "ULQUIER .E LOS I#EMS)(. DE LA MUNICIPALIDAD (/R SER FIRM.O /OR EL /RESI.EN#E .E L "OMISI@N #F"NI" "LIFI".OR .E /RO!E"#OS) SE CON#OCA: GGGGGGGGGGG%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%GGGGGGGGGG%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%