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CITY ELECTRIC SUPPLY
ACCOUNT NUMBER:
St. Lucie County
SCANNED
BY
St. Lucie County
East Florida Division
6827 N. Orange Blossom Trail
Orlando, FL 32810-9521
Ph:407.541.6006 9 Fx.407.541.6010
CONTRACTOR'S REQUEST FOR A JOB ACCOUNT
DATE: 'I
NAME OF CUSTOMER PRIDE ELECTRICAL
ADDRESS: 847 S KINGS HWY'SUITE 104B
JOB ADDRESS: .!/JU LJILLKI
COLINTYf1lT ZUC4�w STATE
FORT PIERCE
NE: (772 ) 461-2777
STATE: FL ZIP: 34945
INVOICE DATE¢� h b 7
_CITY_ �. Sf' LdCCC-L�
ZIP:J fb COMPLETION DATE:
LEGAL: LOT BLOCK PLAT BOOK NOC BK----JPG
SUBDIVISION PARCEL ID: 34.'54OM• 06/3w 000. V.
PERMIT# /'T OL -1 0318 SEC TWP RNG O.R. BK /PG
APPROX. VALUE OF MATERIALS SUPPLIED: MATERIALS/SERVICE: ELECTRICAL SUPPLIES
CREDIT LIMIT: DRAW DATE: 4S-Vh TENANT IMPROVEMENT: YES ENO
SCOPE OF WORK TO BE
GENERAL CONTRACTOR'S NAME: ' A) PHONE:
ADDRESS:
OWNER'S NAM
ZIP:
ADDRESS: & 7la U7" ,Q� .LiCITY: ST L*44 STATE: A ZIPPDXC2.
BONDING COMPANY:
ADDRESS: CITY:
BANK / LEN
ZIP:
ADDRESS: CITY: STATE: ZIP:
You are hereby notified that CES maybe relying in good faith on the information you provide herein to perfect its lien rights under Chap. 713, Fla.
Slat. Should you knowingly provide inaccurate information to the detriment of CES, you may be subject to civil actions under Chapter 713, Fla. Stat. All
terms of the Credit Agreement you signed with CES are incorporated herein accordingly. The
PLEASE RETURN TO YOUR BRANCH FOR PROCESSING PowerT,
Supply You-