HomeMy WebLinkAboutST LUCIE COUNTY UTILITIESiSo�a 01/16
.,WATER
COMM
SEWER
RES
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M/F
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$ CJ 1
SECURITY DEP
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SERVICE FEE
SAME DAY FEE
OVERTENAE FEE
Q METER INSTALL.
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
p LATERAL
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CUSTOMERd
SIGNATURE
ST. LUCIE COUNT'
NAMEr G
ACCT. # I C
SERVICE ADDRESS
14-(= _
I
IES - P.O. BOX 728. FT. PIERCE. FL 34981
SUBDIVISION( rl)(�UA4 'AO / (Q BLOCK
BILLINGADDRESS l 4 (v)Q- NQJC. NO,
W P �- C- e-�)3
PHONE #r( ' _ 4'ram) r v MOVE IN/CLOSING DATE
This application hereby request and authoriies the•Utilitylto 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,prgmptly for such servicesin accordance with the established rules and regulations.
CUSTOMERS�DEPOMTS ARE NONNEGOTIABLE OR TRANSFERABLE.
14 SOCIAL
FED ID SEC/ ;�' y B� 131 -1. 3 bD
NAME OF SPOUSE SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED CASH CHK # RECEIVED BY
St, Lucie'County - PCIS
05-25-2018 02:29:10
17055/6402
NAME, G
ACCT. #
SERVIMADDRESS
a
f
MAN HOMES ` 14 _ I'' k�-.o 5313 OAKLAND LAKE CIR � Af
FORT PIERCE EE FL 34951 �' SUBDIVISION(\AV..W JU4OeT _ , � . BLOCK
E
Amount Tendered: 608.00 L • BILLINGADDRESS . ~ tj\J( 8A JA,
Amount Paid : 608.00
Change Due: 0.00 PHONE / 4 3 —o MOVE IN/CLOSING DATE
Thank You This application hereby request and authoriies the ;Util1,t)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
User ID ; SMITHL the Utility�prvmptly for- such services m- accordance with the established rules.,and regulations.
CUSTOMERStDEP,OSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC'
t� FED ID.
SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE,RECEIVED CASH CHK # . RECEIVED BY.