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—COMM ST.LUCIE COUNTY UTILITIES-P.O.BOX-728,FT.PIERCE FL 34982
ST l UCIE UTILITIES DEP -RES r
NAME
2300 VIRGINA AVE M/F
FORT PIERCE,R 34982 ACCT.#
05/ IRR. '2016 ,11:06;30 — ��-]�
MID!, 488 TID:XXX)IX501 RITY DEP SERVICE ADDRESS Of V All
CREDIT CARD ICE FEE
DISCVR SALE i DAY FEE /9to`�G�BLOCK
Card XXXX�IXXXXl0IX3510 SUBDIVISION LOT
TIME FEE SUBDIVISION
SES: ; 6 BILLING ADDRESS
Ba 887 :R INSTALL.
INV -E 6 VATER
Appr al Code: 01072R
Entry Metlnod: Manual CFC SHONE -r7Q 'V
143 MOVE IN/CLOSING DATE
Mode: Wilt EWER
Avs Code: YYY This application hereby request and authorizes the Utility to render water and/or sewage disposal
Card Code M REV. services to the premises described above in accordance with the Utilities present or future rates,
2AL rules and regulations,which by reference are made a part of this contract.Applicant agrees to pay
��+ the Utility promptly for such services in accordance with the established rules and regulations.
SALE AMOUNT '^1(5 iL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/
I agree to pay above total amount FED ID -(G,Il - ((/ Q
according to card issuer agreement.
(Merchant agreement if Credit Voucher) SPOUSE SOCIAL SEC.
U � OFFICE USE ONLY
CASH f- � RECEIVED BY"J& irLf r
X - C� r I S
MERcrcoPY RECEIVED
MAY 10 2018
ST. Lucie County, Permitting