11990 SW PACIFIC HIGHWAY 11990 SW PACIFIC; HIGHWAY
I
ii
Addreee -� - Permit No. ---
- -- �--�'
Name of OcuupantPermit chargeell
S Qr17
Paid by
---_----- _- —` -- mate connected
Type of Building _ __ Inspection fee _
Service Rate _—_ Paid by
Contractor Assessmeni--_- __ ___-Paid --
Size of connection