11789 SW PACIFIC HIGHWAY 11789 SW PACIFIC HIGHWAY
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Address_�!L (1 4L.G Permit No.__.___14J
Name of Occupant __ Per it charge—
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Date connected—
Type
onnected—Type of Building L tce'Llekaoee Inspection fee—.
Service Rate--a-14-AL Paid by _ _ 1�_Date_
Contractor Aasessment ,7ll Paid
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