12560 SW MAIN STREET 12560 SW MAIN s".-BEET
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New Jdress
Address >2 S 6 G �1��'i i'1��,-y Permit No.
Name of Occupant __ rr p[ Permit charge
Connection feel�['?, c'
_ Paid
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Type of Building -yLG-7�CC.^ Inspection fee---.-..
Spzvice Rate _ . D l _ Paid by
Contractor Asse3sment Paid
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