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-11475 SW HALL BOULEVARD
AddressPermit No.__
Name of Occupant � ��,vt =t � Permit charge
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Paid by_—
Date connected
Type of Building rL1' - - Inspection fee__ ----
Service Rate :� �' y Paid by,— __Dat®
Contractor
Size of connection '`f / _ f"'"`� 'Z 3� � �