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14285 SW 114TH AVENTIE
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ADDRESS I �"��5,_ � — 11FRMIT N0, I8
PERMIT CHARGE nom,
DINER ..._._ �.�.� .�..� CONNECTION FEE X40.
PAID BY
TYPE OF BUILDING IA,4/ DATE CONNECTED ._
SERVICE RAIL �.L.� INSPECTION FEE C;2
PAID BY DATE
^- CONTRACTOR
SIZE OF CONNECTION ASSESSMENT PAID
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