11925 SW LINCOLN AVENUE 11925 SW LINCOLN AVENUE _
I
a
a
3
t/]
Ln
N
Ch
1
Address 1 � _- Permit Nu.
I f --� -
Name of Occupant Permit charge
Paid by_�
��-_._._--.--_--_-- -------_._. Date connected__ ---
T;•p,a wI BufldingInspection fee-- — ---...
Service Rate-_-)- � � Paid by _ Date
Contractor Assessment_ -��.� Paid__
Size of connection