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12060 SW LINCOLN AVENUE 12060 SW LINCOLN AVENUE•' 1 4 0 u C r7 �D 0 N Address -���o� -1�s Permit No. _ Name of Occupant_ _ Permit charge._. --�a.etK� _ Connection fee_ -- --- Paid by-- -- q — Date connected Type of Building_ ���rf _ Inspection fee__________`__ Serv4.ce Rate Paid by _ . Date_`__ Contractor Assossment Paid Size of connection