11825 SW PACIFIC HIGHWAY 11825 SW PACIFIC HIGHWAY
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Address 1 2,1, i?ermit No.
Name of Occupant Permit charge
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----- - Paid by.___.-- I —
Date connected /
Type of Building_ 0-1'.rC.
.7
A _6614 -,.F Inspection fee
Service Rate�� ' V _ Paid by
Contractor — Assesiiment_____
Size of connection._„_