Alvarez, Isaias _ ___ __
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BACKFLOW REGISTRATION FORM
Registration is for one year from the date of registration or re-registration.
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City of Coppell Public Works Dept.
816 S. Coppell Road
Coppell, TX 75019
972-462-5150
www.coppelltx.gov
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BILLING CONTACT �
Isaias Alvarez
Fire& Life Safety America
1100 Valwood Pkwy,#114 •• •��
Carrollton, Tx 75006 �a
INVOICE NUMBER INVOICE DATE INVOICE DUE DATE INVOICE STATUS INVOICE DESCRIPTION
INV-00011667 09/06/2018 09/06/2018 Paid In Full NONE
REFERENCE NUMBER FEE NAME TOTAL
Misc Fee Backflow Contractor Registration $75.00
SUB TOTAL $75.00
REMITTANCE INFORMATION TOTAL $75.00
City Of Coppell
P.O. Box 9478
Coppell, TX 75019
September 24,2018 255 Parkway Boulevard, Coppell Texas 75019 Page 1 of 1