11670 SW 95TH AVENUE-1 11670 SW 95TH AVENUE
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Addsea L�_ --- r. a4le, Permit No.
Name of Occupant_ Permit charae
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Paid
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Type of Building_ `�
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Service Rate_,_ , (f /� _ Paid by _Date___, _
Contractor_ Assessment;_ Paid___
Size of connection
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