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9235 SW CENTER STREET
Address Permit No.
Name of Occupant—__ Permit charge
Conueci -m fee_ D 0.
�_— -- --- aid by
___- _ _ ------------ _---__ Date connected
�q of Building_�,4�•� - Inspection fee---
Service Rater
—.�11_�/ __- Paid by Date
Contractor � —- AssemmenI Paid
Size of connection_ 4__ &23