HomeMy WebLinkAboutReciept WATER COMM ST LUCIE COUNTY UTILITIES-P.O.BOX 728,FT PIERCE,FL 34982
SEWER RES NAME.
METER SZ. M/F
IItR ACACCT.#
$ 7� SECURITY DEP SERVICE ADDRESS �l
SERVICE FEE
SAME DAY FEE
SUBDMSION LZ L, LOT_ S BLOCK J
( ( OVERTIME FEE
`f��C ✓ METER INSTALL.' BILLINGADDRESS l Je-P 1
u
CFC/WATER � ye.fC�
FPUA CFC PHONE#�� — .J i'�' 7�[ 1 MOVE IN/CLOSING DATE
CFC/SEWER
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GUAR.REV. 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,
LATERAL 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.
$ TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER /j SOCIAL SEC/
SIGNA FED IDI
NAME OF SPOUSE �,� r'�li! �� (� . � f� SPOUSE SOCIAL SEC.
OFFICE USE ONL
DATE RECEIVED L� -� � -CHK#M
RECEIVED St. Lucie County - PUTIL
08-10-2021 03:06:07
AUG 10 2021 21222/5202
GIBBONS AMI
St.Lucre County FORT PIERCE
Permitting FL
34982
Amount Tendered: 521 .25
Amount Paid: 521 .25
Change Due: 0.00
Thank You
User ID: MURRAYA