11360 SW 92ND AVENUE-1 � 4
11360 SW 92ND AVENUE
v
C
61
7
d
,b
C
N
3
O
�O
r+�
Address _9L _�/ _ Permit No.
Name of Occupant Permit charge
Comeefiec
Paid by
Date connected
Type of Building .. Inspection fee
Serdce Rate--2,--,a 0 Paid by _----Date
Contractor Assessments�f, c'D Paid_
Size of connection ( 9
s