HomeMy WebLinkAboutST LUCIE COUNTY UTILITYX
WATER
COMM
SEWER
VT RES
METER SZ.
M/F
IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.
3 i
CFC/WATER
i`(-)
FPUA CFC
/ CFC/SEWER
112, , DO GUAR. REVS
I�'7S LATER'r
$ 5 WGJ - TOTAL
CUSTOMER
SIGNATURE
ST. LUCIE COUNTY UTILITIES - P.O. BOX 728, FT. PIERCE, FL 34982
NAME
ACCT. #
SERVICE ADDRESS J(1r- O-T !'1, /
SUBDMSION � AO ) AG.�/I` S LOT BLOCK
BILLINGADDRESS 3 � �( �lj
S-L , T7 �3 E,P 3 •ASS
PHONE # ? 7) MOVE IN/CLOSING DATE
This application hereby request and authorises 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 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.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
NAME OF SPOUSE
SOCIAL SEC/
FED ID
SPOUSE SOCIAL SEC.
DATE RECEIVED )Q I /7 CASH OFFICE USECHK #ONLYO(�� �7 RECEIVED BY
St. Lucie County - PCIS
04-20-2017 12:55:56
76674/6122
BLUE, HARRY
MIDWAY AND MCCARTHY
FORT PIERCE
FL 34947
Amount Tendered: 5,763.00
Amount Paid:
5,763.00
Change Due:
0.00
Thank You
User ID: RODRIGUEZM