12115 SW HALL BLVD r
t
r�
I,
i
12115 SW HALL BOULEVARD �'�r'
Address � __ Permit No.
Name of OccupanPermit charge _
--- �.- Paid by— -- ------------ .
Date connected
T;pe of Building �d�F •�„�_ Inspection fee
Service Rate ' Dy
Paid by - -- - Date
---------__.._.._--
Contractor___.— _ Ae;sessmeut Paid
Size of connection /y �t