HomeMy WebLinkAboutProject Information ST LUCIE UTI
IRGINA AVE I .
FORT PIERCE,FI.34982 '
�22j2021 11:51:26
MI:p;�}U(XXXXXXR488 TID:I0000(501 c tin ST. LUCIE COUNTY UTILITIES - P.O. BOX 728, FT. PIERCE, FL 34982 .
CREDIT CARD RES NAME 1- /Gil Q Ce
VISA SALE M/F
N_ Xf000000(9878 ACCT.#
Card�( p o ro
SEQ 1{: >W�, c�a oej
7 IRR
Eatch q; ey J 1627 URITY DEP ERVICE ADDRESS b� 7 �N U� �C2.C� FL
INVOICE Et 7
t9proval Code: 005126 VICE FEE
Entry Method: Manual
Mode: Online I DAY FEE UBDIVISION IRE
- M LOT . BLOCK
Card Code: RTIME FEE °
SIDLE AMOUNT $521,25• 'ER INSTAL BILLING ADDRESS lioO/ 8/2C4 dZ �T f EI'2Cf f: . _3Y982-
`WATER EMAIL ADDRESS: r►F K,t 1 s Ftt /J XQc
' I agree to pay above total amount
according to rd issuer agreement. CFC PHONE# Li5603 Z�/—(o�},P�� � MOVE IN/CLOSING DATE
(Merchant agr ment i �57'"E'SEWER
D. •
AP R. R This application hereby request and authorizes the Utility to render water and/or sewage disposal
services to the premises described above in accordance with the Utilities present or future rates, rules
AM l and regulations,which by reference are made a part of this contract.Applicant agrees to pay Utility
CHANT COPY IL promptly for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SIGNATURE SOCIAL SEC/FED ID_ <-93 2- 5-3
�
NAME OF SPOUSE �l
3FSSICA SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED q'o�o�'c�-( CASH k RECEIVED BY
V I acknowledge Base Facility Charges beginning for water and/or wastewater on the daythe meter and/or service is installed b
Y
t County,regardless of when a customer connects to or starts utilizing the meter and/or service.
!,/ I acknowledge upon activation of service,I will be billed and am obligated to pay the Base Facility Charges.