12130 SW 92ND AVENUE 12130 SW 92ND AVENUE _
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Address 7 1i Gi(/'-Q Permit No.
Name of Occupant Permit charge —
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Connection fee -
- -- Paid
Date connected
Type of Building �� � +v-� _ Inspection fee`_.__
Service Rate7 0 Q Paid by
Contractor__ /� '< � ''l Assessment_
Size of connection_-_Ljg