9815 SW MCKENZIE PLACE 98i5 SW MCKENZIE STREET
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Address �1�w� ,"G/o�� 'd Permit No.
Name of Ocoupant = Permit charge —
!` Connection-fee
_ Paid
Date connected
Type of Building Inspection fee�__�.___—_ —
Service Rate _., . �� d Paid by __.___ ..__Date_
Contractor Assessment---Paid
Sire of connection