12095 SW LINCOLN AVENUE 12095 SW LINCOLN AVENUE
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Address_�_ � _� (���p�- Permit No.,_.__._
Name of Occupant___---y_ Permit charge
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Paid uY-..
-- - -- -- — - ----— Date connected- -1-----�- ---- ----
Type of Building"4t Intipection fee
Service Rate 2,,0 )- Paid by --_ __--
- --- Date-------
Contractor _-- Aneessment Paid
Size of connection