11630 SW GREENBURG ROAD-1 11630 SW GREENBURG ROL: +}'G;
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Address 1110 I-La, W), j� Permit No. _ J Y Z
Name of Occupant,,. .!rZ3,a AC L�'c �,. Permit charge
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Date connected
Type of Building �'"" �`" Inspection fee_�___�`
Service Ratey Paid b __Date__
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Contractor _-- Assessment_j,� _� f. Paid
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