11755 SW HALL BLVD i
id �l
v
vl
LI;
cn
.y
11755 SW HALL HUULEVARD
a
ti
Address Permit No..
Name of Occupantj41 TYCilcl-IL � Permit
---- _— Paid by--- --—
-- --- — -- ---- Date connected ak,
'hype of Building � t: ...i�.^i ��---- -- Inspection fee--_ —
;ervico Rate__ ;�, + Paid by
.-------_..._ Date
Contractor.___ _ _ _ Assessment— Paid
Site of connection _-_- - — _—— `L' G- r
i�
t