11900 SW PACIFIC HIGHWAY 11900 SW PACIFIC HIGHWAY
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Addies;_ �Q Permit No, 30LJ
Name A Occupant Permit c arge
Paid by _ _
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Date connected
'type of Building( ����. Insprc'Lion fee
Service Rate Paid by
Contractor_LIQ/�Zl�L�v Assessment______ Paid
Size of connection--
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