Start Utility Service - New Construction 

Utilities Commission, City of New Smyrna Beach, Florida
Phone (386) 427-1361 | Fax (386) 424-2713 | www.ucnsb.org
Contact Information - Individual
First Name:
Middle Initial:
Last Name:
D.O.B:
Social Security #:
Phone#:
Current Address: 
*E-Mail:
City:
State:
Zip Code:
Contact Information - Company
Company Name:
TaxID:
Company Address:
*E-Mail:
City:
State:
Zip Code:
Phone#:
Primary Contact
First Name:
Middle Initial:
Last Name:
Mailing Information (if different from above)
First Name:
Middle Initial:
Last Name:
Mailing Address:
 
City:
State:
Zip Code:
 
Requested Service Information
Service Address: 
Service address is:
Business Residence
City:
State:
Zip Code:
 
Services Requested
Temporary Electric:
Overhead Underground** None
Permanent Electric:
Overhead Underground** None
Potable Water:
Yes No
Meter Size:
Sanitary Sewer Service:
Yes No
 
 
Bright Water:
Yes No
Meter Size:
Irrigation Meter
Yes No
Meter Size:
Type of Irrigation Meter:
2" Temporary Fire Hydrant Meter:
Yes No
 
 
2" Temporary Construction Meter:
Yes No
 
 
* REQUIRES CORPORATE PAPERS ON FILE (fax to 386-424-2713)
** Underground Areas Only
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Customer Verification (initial)
Applicant/s Signature
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