Cartwright, Roger City of Coppell, TX
Public Works
255 Parkway Blvd, Coppell, TX 75019
Coppell, TX 75019
972-304-3500
Welcome
002038-0001 Debbie T. 12/10/2018 10: 54AM
ENERGOV INVOICE
Cartwright, Roger (BluFenix Fire Solutions)
2018 Item: INV-18-00013344
Balance due: 0. 00
Balance unpaid: 0 . 00
Backflow Contractor
Registration 75 . 00
Payment Id: 10905
75.00
Subtotal 75. 00
Total 75.00
CHECK 75 . 00
Check Number 13506
Change due 0. 00
Paid by: Cartwright, Roger
Thank you for your payment
CUSTOMER COPY
DUPLICATE RECEIPT
T H E • C [ T Y • O F
�C�PPELL
y�N`•�.'�.1j,1..t�r i �r;rtV,r-�.. :"
IZ.� i. :-k ,r,�_�;
"f' �y:;�':��'.S � �� is�t'.:- � �•
{=�s�
1 :=�1•�..�,;i���` 0
E' fi '����• �., �•Gr- b Q
City of Coppell Public Works Dept.
816 S. Coppell Road
Coppell, TX 75019
972-462-5150
www.coppelltx.gov
BACKFLOW REGISTRATION FORM
Registration is for one year from the date of registration or re-registration.
Date of Registration � / / �G ����
Name: /k� �y' /� '' { L 1� l
' /"� j 1/
-L'-t-^��G 4C- `I�\L f ✓l�`�"1 1 Y`l�
Name ofCompany: ��;�r�-;.i, ,� �-;,� `'���(-���„� ;
MailingAddress: ��� Z ���=� ��^ �� � �( ��`
__2 �'l �c� .�.�.� �/-i�� �G� Z �
(Street&Number/PO Box, City, State and Zip)
Physical Address:
(Street&Number, City, State and Zip)
Office Phone Number:
Mobile Phone Number: �J�C �'C � ��'/Z- 7
E-mail Address: ,rc�;Erz, Cv<,��„�;f,��,.(-'7 I �� �,�.,�,:�' 1 , �c.�