9775 SW LAKESIDE DRIVE X3775 SW LAKs. SIDE. DKIVe
1
w
C]
v
b
y
Gl
a
3
V)
un
I
M
ADDRE5S '177 1 Lfi' ,�d re.�4 PERMIT N0.
PEPMIT CHA! ,;E node
OWNER COPJPJECTI(';J FEE
PA:O BY
TYPE OF BUILDING J'Cz& DATE CONVECTED
SERVICE RATE _ �� INSPECTION FEE a�
Cr,NTP,AC f0R PA IO BY DATE.
SIZE OF CONNECTION _ � ASSESSMENT _ __ ____, PAID