11739 SW PACIFIC HIGHWAY 11739 SW PACIFIC HIGHWF.Y
1
x
•4
k4
• 4
U
ro
3
rn
M
I �
i
Addreu—z Permit No.
Name of Occupant. Permit charge
Gertnect on ie 0-0
_ Paid by._ -
Date connected
Type of Building j2i 4,,L&Adm 4 -_ Inspection fee----.--
Service
ee______Service Rate 2- , 6 _ Paid by - _-___Date—
Contractor Asseesment_ _ U_Paid_
Size of connection
I