9595 SW LEWIS LANE 9595 SW LEWIS LANE
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Address Permit_ �s�_�. 4_Qi Permit No. _
Name of Occupant _ Permit charge
Paid by— — — ----
Date connected
TyT,e of Building , Inspection fee.._-----_--
Service Rate ���_— Paid by
Contractor-- ------ Assessment--- Paid
Size of conuection.__
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