11700 SW GREENBURG ROAD-1 11700 SVS' GREENEURG RO!M
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Addreee LJDO 1 0i")PdC Permit No.
Name of Occupant LL Y-jey+_c,p J_6�� Permit charge
Connection fee
0414
-- _-- FA id by
Date connected
vpe of Building � �t _ Inspection fee
Servi,^.e Rate__ Paid by Date__
Contractor Assessment 1 GGc
Size of connec`ion �-