12135 SW TIPPITT PLACE 12.135 SW TIPPETT PLACE
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ADDRESS PERMIT N0.__ (n
PERMIT CHARGE none
OlJ'JER CONNECTION FEE
�..__ PAID BY
TYPE OF BUILDING DAZE CONNECTED
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SERVICE RATE 1 I .,PECTION Fc-'E
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CONTRACTOR __- PAI) BY _ _ DATE _ -
SIZE OF CONNECTION �M _ ASSE:SSUNT PAID
:3 y So o/
• S = 77 ' �`