11695 SW 90TH AVENUE 11695 3W 90TH AVENUE —
s
Address ��� Pe-mit No.---Z2
�
d
Name of Occupant pPe r }it charge
Paid by
Date connected Z : l`
Type of Building_•��s �- ��w-!s Inspection. fee _
Service Rate v 0 U - Paid by _ �__Date----_-_-.--_--
Contractor —_ Assessment ,�y�t O Q--Paid (Yate
' Size of connection_ _—_