11981 SW PACIFIC HIGHWAY E--- m
11981 SW PACIFIC HIGHWAY
I
I
r
u
w
ao
o�
�Y
r
i
i
Address_ /_� � Q,(i Permit
Name of Occupant _exg-e" Permit charge . ----- - — ----
-- Connection fee��
- - Paid by — -- -- -- ---/ -
_ --_- Date connected
Type of Building .�� r
- -- _ Inspection fee-.
Service Rate_ _ L aid by Date
Cnntiactor r[' � cA ,i •� Assessment_____ -- Paid
Size of connection C-7-7