11802 SW 91ST AVENUE 11802 SW 91ST AVENUE
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Address_-` 1?1" z, Permit No.
Nam :of Occupant),yit�. I+.��Lo�^0�1! ;t„ w Permit
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Date connected
Type of Building �) Inspection fee _ -- -- —
Service Rate. 2 i �`�/ _ Paid by Date
Contractor f��;.� L- C�J� __�_... Assessment__ _ _ _Paid _
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