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HomeMy WebLinkAboutMiramar I Condominium_178245_Security Bond Form_2021-04-29 Building and Code Regulations Division Permitting and Zoning 2300 Virginia Ave Ft. Pierce, Fl 34982 772-462-1553 Cash Security Fund, Irrevocable Letter of Credit or Bond to Secure Cost of Removing an Antenna, Antenna Array or Tower Service Provider Information 1.Name: ______________________________________________________ 2. Address: ____________________________________________________ _____________________________________________________ Phone Number: ________________ Fax Number: _______________ 3. Location of Tower (Address):___________________________________ 4. Parcel Identification Number: ___________________________________ 5. Lease Holders Name & Address: ________________________________ __________________________________ __________________________________ Phone Number: __________________ Fax Number: ______________ 6. ID Number of Bond, Irrevocable Letter of Credit or Check: ___________ 7. Permit Number of Tower, Antenna or Antenna Array: _______________ Page 1 of 2 Verizon Wireless 4700 EXCHANGE CT, BOCA RATON, FL 32667 916-385-4266 9950 South Ocean Drive, Jensen Beach, FL 34957 4502-703-0000-000-1 Verizon Wireless 4700 EXCHANGE CT, BOCA RATON, FL 32667 916-385-4266 K09342539 TBD