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11640 SW 95TH AVENUE-1 w w v v v W WW T - 11640 SW 95TH AVENUE I i I v C OJ u vn Q+ 3 I Address.,.,/16 �__9�G� � Permit No. i Name of Occupan".- Permit charge Paid by--- - __ ------ -----.-.-----------__- Date connected Type of i3uilding Inspection Service RatePaid b 0 (% Date y _._----- -- Contractor_--„_ _ A�iressment j,9_q P,yid Size of connection