HomeMy WebLinkAboutProject Information R E C E I V r D JAN 2 2 2016 -ST.LUCIE.CO.UNTY UTILITIES-P.O.BOX 7281-FT.PIERCE-FL 34982
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NAME
St. Lucie County -PCIS
011-22&2016- - Cre'F.46 ACCT.# I r ' -✓ r
A TOl Z PROPER IES, SERVICE ADDRESS - I D � 1 t
6103 MYRTLE DR
FORT PIERCE
FL 34982 ^n
Amount Tendered: 519.00 svBDvlsroN =�1�-� "LOTBLocx
Amount Paid: 519.00
BILLINGADDRESS
Change Due: 0.00 n wu
Thank You
PHONE# MOVE IN/CLOSING DATE
User ID: WARDD =
This application hereby request and authorizes the Utility to render water and/or sewage disposa
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 pa3
the Utility promptly for such services in accordance with the established rules and regulations
$ TOTALCUS.TOMERS;DEPOSITS ARE NONNEGOTIABLE ORTRANSFERABLE.
:CUSTOMER " �- SOCIAL SEC/
SIGNATURE V FED ID
NAME OF SPOUSE SPOUSE SOCIAL SEC.
t OFFICE USE ONLY
DATE RECEIVED CASH CHK# . RECEIVED BY�