HomeMy WebLinkAboutPSL UTILITITY NEW RESIDENTIAL SERVICE APPLICATIONXITIYOF-PORT ST. LUCIE UTILITY SYSTEMS DEPARTMENT
NEW RESIDENTUL SERVICE APPLICATION
NEW CONSTRUCTION
SCARED
1017196-925211
Custotner - Account
WATER Capacity: (One ERQ:
Account Name: SYNERGY HOMES LLC Con
Cie
NON SAD/USA Une Fee:
Service ddressi: 12192 RIVERBEND TERRACE,.-....,,,,..-.,
SAD/USA U" Meter Fee:
NON SAD/USA X" Meter'
PO Fee:
city. RTSTLUdE State: FL ?ip: 34984-.6431- TOTAL WATER:
Mailing Adefressi'581PW MERCANTILE PLACE SU . ITE 108 PORT ST LUCIE FL' SEWER Capacity: (One ERC):
$1,401.00
$722.00
$ 630.OD
$2,753.00
34986-2256 NON SAD/USA Line Fee:
Grinder Installation: $
PrimarY.Phone#: (561)662-3287 LPS Installation Fee:
I.D.# ******0163 SeptIc5erv1ce:,
Gravity Sewer:
TOTALSEWER:
Security Deposit Water $50.00
Security Deposit Sewer: $
129RL29%� LOT2BAYSTLUrJE Recording Fee: $
PlEft 01 RApk 455
LESS DEPOSIT& RECORDING $
Aqne- NON T(YrALAM UNTDUF_- $2,803.00
[—]Cash rICreditcard E]Check#
RECEIPTN. DATEPAID: 08/2012019 BY, ]lOAQUINF
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Customer Signature
Date