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New Service- Business Application

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Steps

  1. 1. Step One (current)
  2. 2. Step Two

  • Step One

    2. DAVE LOWERY

      MAYOR

      CHRIS LIGHTFOOT

      INTERIM CITY MANAGER 

      AMY MYERS

      CITY ATTORNEY

    3. CITY OF LYNN HAVEN LOGO (1)

    4. COMMISSIONERS 

      SAM PEEBLES 

      PAT PERNO 

      JAMIE WARRICK 

      JUDY TINDER

    6. REQUEST FOR NEW SERVICE-BUSINESS APPLICATION

      $150 REFUNDABLE DEPOSIT & NON REFUNDABLE CONNECTION FEES

       $50.00 PER METER (INSIDE CITY LIMITS) & $62.50 PER METER (OUTSIDE CITY LIMITS)

    28. Would you like to enroll in phone notifications?*
    29. Would you like to enroll in E-mail notifications?*
    31. Turn on the Irrigation meter if applicable?*

      Additional Connection fee of $50.00 (Inside City Limits) or $62.50 (Outside City Limits). All irrigation systems are required to have a RPZ type of backflow device installed before we can unlock the meter for use. Failure to comply does not waive the applicable fee

    33. Would you like to enroll in paperless billing?*
    35. Request a second garbage can for an additional charge?*

      Residential Garbage: 90 gallon can already included. 

    37. Commercial Garbage

      (IF APPLICABLE)

    46. Agreement

      I HAVE READ AND UNDERSTAND THAT BY SIGNING BELOW, I AGREE TO THE FOLLOWING:

      If an incorrect address is given above, there will be an additional water connection fee for each corrected meter. The city cannot turn on an irrigation meter unless it has a RPZ type of backflow device installed. Failure to comply does not waive the applicable fee. The FDEP has mandated that all irrigations be equipped with a certified backflow protection assembly. It is the responsibility of the homeowner to ensure the backflow preventer is recertified every two years and maintained in good working order, in accordance with the FDEP rule 62-555.360. Failure to have the correct assembly installed will result in termination of irrigation service.

      I assume all responsibility for this account whether I reside at this address or not. I understand that in order to disconnect services I must complete and submit an account closure request.

      All faucets at the address must be in the off position before water services are turned on. The City shall not be held liable, and the account holder hereby releases the City from any damages due to the account holder's negligence in The City collects your Social Security number for the following purposes: classification of accounts; customer identification and verification; credit worthiness; customer billing and payments; benefit processing, tax reporting and any other lawful purpose necessary to conduct City business. Social Security numbers are NOT public records, but may be released to other governmental or commercial entities as required by law Section 119.071(5), Florida Statues.

    48. Electronic Signature Agreement*

      By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.