11585 SW HALL BLVD i�
P
I
00
Un
E;
I
15Ei5 sw finis, I)Vn1r,Fv� n
4�d►-y`IX-G►1, i..�iY.L�-5t" 6" 6
XddlIM ��A' / Permit No. .
Name of Occupant U, � "-,a&� Permit charge_
Paid by
Late ce-inected
Type of Building VLE�GLF ►�/ _ Inspection fee-
Service Rate D
Peid by _...----------Date_
Contractor, �_. - Asseenment__��__.
Size of connection '��