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HomeMy WebLinkAboutUTILITIESi I SCANNED i St.. Lucie County - PCIS 04-19-2018 03:44:16 RY4AN1H055�6369'i FORT PIERCED .LAKE CIR,. FL 34951 Amount Tendered: 608.00 Amount Paid:, 608.00, Change Due: .0.00 Thank -You =CEIVEI i 0 2 Z018 5 1. Lucie CeiAnty, Permitting . ST. LUCIE COUNTY UTILITIES P.O. BOX 728, FT. PIERCE, FL 34982 NAME`` �iJ` 'r\ \ b ACCT. # t j 0 �1(J - ! - SERVICE ADDRESS''- SUBDMSION D LOT —7 BLOCKI III ' BILLING ADDRESS � li\ };1 1 'R,- 1 o �_�ao -,360 MOVE IN/CLOSING DATE User ID: MURRAYA 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 9 the Utility promptly for such services in accordance with the established rules and regulations. $ 6:) n S TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE. CUSTOMER �A� f (,� SOCIAL SEC/ - SIGNATURE V " �. '`--i - l�{FED'ID NAME OF SPOUSE SPOUSE SOCIAL SEC. f OFFICE, USE ONLY 2 DATE RECEIVED '4-19"i CASH CHK # Q 3�RECEIVED BY _/