JOHN DENNY GARCIA City of Coppell, TX
Public Works
255 Parkway Blvd, Coppell, TX 75019
Coppell, TX 75019
972-304-3500
Welcome
002558-0001 Debbie T. 03/05/2019 12 : 20PM
ENERGOV INVOICE
GARCIA, JOHN DENNY (ACTION FIRE PROS)
2019 Item: INV-19-00015622
Balance due: 0. 00
Balance unpaid: 0. 00
Backflow Contractor
Registration 75 . 00
Payment Id: 13236
--------------
75.00
Subtotal 75.00
Total 75. 00
CHECK 75. 00
Check Number 56663
--------------
Change due 0. 00
Paid by: GARCIA, JOHN DENNY
Thank you for your payment
CUSTOMER COPY
T H E • C I T Y • O F
�CJPPELL
. �a�i^1y`�,4 r. �..^a •r��iK-„ '��
. Y�.`�"'�"'.'�� �y �ir�+•�' —` �
f �:�.� � '�'�`L�J�'�'�'�
L� � �•�.'4•�'�' D Q
A �, , t
City of Coppell Public Works Dept.
816 S. Coppell Road
Coppell, TX 75019
972-462-5150
www.coppel Itx.gov
BACKFLOW REGISTRATION FORM
Registration is for one year from the date of registration or re-registration.
Date of Registration cj / �/ / �I
/ r� /+
Name: �G!')Y1 l�Yl � �� (��/"G! �i
Name of Company: � C'�'+^� �'1 ��^r'C �/'7� S
/1
Mailing Address: /�O /3v Y ��7 ' ��X Gi �(�i��, '�]'u � 7 6 t S�
(Street&Number/PO Box, City, State and Zip)
Physical Address: � ►�Y�
(Street&Number, City, State and Zip)
Office Phone Number; ��l� ' S�0 - ZZ �7
Mobile Phone Number: G} "7 Z - 9 a2l- 7 0 ��
E-mail Address: L►' Aal^C�ci Q or c'i�io» �,,�(pnJ S. Lu✓�"�
�
�: .
I� T H E • C 1 T Y • O F ` .,._. � , ... ......:. :.� .__. .,. ..
` � COPPELL f
�
;�������,� ;� >�;����=�'� �
>�
T����� �
F`�,�. ,s"�`"�'q
�
A s � P
�
P.O.Box 9478•Coppell,Texas 75019•972-462-5150
� � Utility Operations
__-.. ,/+
, Name Jof^:�!,/ �C/E.✓'.y'U �,A,✓Cd c�� '
,/� � � �� ��/� � f
, Service Address !" (� �g r �n/3�'�!i'�' L�1�-
i � �� ���� �
� Phone Number � �� �� ����
a Date Cash Check o. «'`�"'�� �
' � METER NO. RDG.
Utility Security Deposit ��
Water Meter Sales
Backflow Registration � � '�`' �',
s�
SI
?.�
��
'; �
��� �
I
i !'� I .. _. .. _........... .. . . .
(
�
215 3 � l � ��
�;� ,o' .�,y,r,p,, s �
,.. . CCC-0� Receivec F;�