11495 SW HALL BLVD ti
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11495 SW HALL WJULEVARU
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tAcidress /`7 Permit No.
Name of Occupant_� �� Permit charge
Paid by_-_-_--
Date crnnecteu
Type of Building ����Z?�jy_,t/- __--_-- Inspection fee—
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Service Bate cX �` Paid by __. __.Date
Contractor Assessment fj,L , 1 D paid __ v
Size of connection _— -
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