11700 SW 95TH AVENUE w
].17OG SW AVENUE .._._
0
I
v
a
v
a
,n
u
u1
3
O
O
n
I
Address
Permit Vo.
Name of Occupant Permit charge
44=L�e —J-0 A
Paid by
Date connected
Type of Building LAG Inspection fee----
Service Rate---- Paid by Date--
Contractor Assessmenl,._4�t quid
Size of connection