11963 SW PACIFIC HIGHWAY 11963 SW PACIFIC HIGHWAY
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Address_1� 'Ll____------- Permit No.----- _�—_-'�
Name of Occupant_ ,.— Permit charge
Connection fee-- _ a L12
---- - ---- -- Paid by
Date connected
Type of Auilding&waalja,4_lA�.tte-_ Inspection fee
Service Rate Paid by Date W
Contractor Assessment_____
Size of connection_�f�►_�_
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