City of Lakeland 501 East Lemon Street Lakeland, FL 33801-5079 Fax 863-834-1413 Phone 863-834-9535
CONSTRUCTION APPLICATION FOR UTILITY SERVICE
Please fill out this form in its entirety
Account Name: ____________________________________________ Master Acct#: __________________
Billing Address: ___________________________________________________________________________
E-mail Address: ___________________________________________________________________________
………………………………………………………………………………………………………………………
►Service Address: ___________________________________________________Zip code: _____________
►Required Legal Description: _______________________________________________________________
(sub/ lot/ Phase# or 18-digit Parcel ID #)
►PLEASE ADVISE: _ olk City __Inside city limits ___Outside city limits ___P
►
Required Building Permit#: ____________________________________________________________________________
IS THIS A CORNER LOT? ___Yes ___No
►If yes, what direction does the front of the house face – (N, S, E, or W) ___
and the driveway faces - (N, S, E or W) ___
►A
p
plicant Name: (Please Print) _____________________________________ Day Phone: _______________Ext: _______
Partnership or Corporation, Federal ID # ________________________________________________________________
le Owner or Residential Customer, a Photo ID is required. DL# _____________________________________________
______________________________ Date of Birth ________________________________
ignature hereto, I certify that the above information is correct. I understand that all utility charges are due when
►I
f
If So
SS#
By S
ren
dered and the customer will pay all costs, charges, and expenses, including reasonable attorney’s fees for the collection of
all unpaid balances.
►Signature and Title: ___________________________________________ Date: _____________________
(Title required only if Partnership or Corporation)
Revised-1/29/18
Account# ________________ Location#__________________ L.E. Representative __________
TEMP: Temp Elec for a _ T-Pole or _ TUG to build a single-family home – duplex/apt – other ______
#
CONST:
_ Temp Elec T-Pole to build multiple homes ___
#
COMM:
__ Temp Elec T-Pole to build a commercial building __
P
ERM ELEC: __ Permanent Elec for a:
_ Commercial Building ___ Single-Family Home ____ Duplex/Apt ____ Mobile Home or ____
__
*IF REQUESTING PERM POWER – Clearance must be received for perm power before we will energize the structure. *
W
ATER SVC:
__ Residential-3/4-inch water meter; if not ¾-inch, please specify __________________ __
VC: ____ All Co
mmercial water meter requests must include a required Water Eng allocation form and letter.
click to sign
signature
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