12100 SW 92ND AVENUE I;"_ I
12100 SVJ 92ND AVENUE
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Address j_2_Mo_ _-aA/-"-' Permit No.
Name of Cccupant� Permit charge
Connection fee 0 0
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Type of Building 61 _- Inspection fee
Service Rate_ _ 2 '00 ✓� ___ Paid by
Contractor Assessment —Paid
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Size of connection,__:
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