12657 SW PACIFIC HIGHWAY 12657 SW PACIFIC HIGHWAY
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Address 6 S 7 XJ`�/��'�`� Permit No. ___
Name of Occup tjWj,&,l)� U, � Permit r.} ;Yzge
Connection _—
Paid by--- -- _—
Date connected
Type of Building ,---------LO -- Inspection fee -
Service Rate ___ Paid by Date _-
Contractor_J- _�-_ Assessment_- __._.Paid
Size of connection __