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M , ST LUCIE COUNTY UTILITIES - P.O. BOX 7,28, FT. PIERCE, `FL 34982 "
St. Lucie Countyy - PCIS
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ME
'ACCT, #
07-16-2018 01:22 :29
16065 6499
COASTAL C NSTRUCTI
1
SERVICE
4832 WATERSONG WAY
EP:
ADDRESS 1• G!f`�'�: 7
FORT PIERCE
FL 34949
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Amount Tendered: 1,845.25
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Amount Paid: 1,845.25
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SUBDMSION LOT BLOCK
-
Change Due: 0.00
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•BILLING ADDRESS. �. 315- /� 1 S1 13'}4 G,�-' 'L.d..•'/¢ '%
Thank You
User ID: WARDD
-PHQNE # 7 72 24 0 - -Z) % MOVE'IN/CLOSING DATE
This application hereby request and authorizes the Utility, to render water and/or sewage disposal
se_ _
rvicc to,thm e pretses described above in accordance with "the, Utthties;present or future rates;
,LATERAL,
'rules•and'regul'ations, which byrefecence are made a part of this.contiact, Applicant agrees to pay
the Utility promptly for such services in accordance with the established' rules and regulations.
CUSTOMERS DEPOSITS' ARE.NON NEGOTIABLE, OR TRANSFERABLE.
CUSTOMER,%//f %/f SOCIAL,SECI
SIGNATURE 1 // `�—� FED ID
NAME OF SPOUSE SPOUSE SOCIAL SEC.
(r f r O_ -MCE, USE ONLY i f
CASH �/ �`v Q
DATE RECEIVED, f // CHK-719 e� S RECEIVED BY