12815 SW PACIFIC HIGHWAY 12815 SW PACIFIC HIGHWAY
I
3
.r,
u
a4
.4
u
m
3
N
U2
00
N
I
Addreu 11- (Aps. '14 - Permit No.
Name of Occupant ��it rim. — Permit charge __a—
Paid by_.—
Date connected
Type of Building_ V� Inspection fee
l
Service Rate b Paid by ___Date_
Contractor d'ru ru__ Assessment-37it,11 -PaidY__
Gid
Size of connection, _
y.,
tY