HomeMy WebLinkAboutApproved Security Bond DocumentBuilding 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.
7.Permit Number of Tower, Antenna or Antenna Array: _______________
Page 1 of 2
Liberty Mutual Surety
175 Berkeley Street, Boston, MA 02116
617-357-9500
12200 Angle Road
1332-211-0002-000-5
T-Mobile South LLC
1300 Concorde Terrace, Suite 200
Sunrise, FL 33323
954-444-2822
ID Number of Bond, Irrevocable Letter of Credit or Check: 674215517
Cash, Security Fund, Irrevocable Letter of Credit or Bond to Secure Prior
Service Provider Information (If Replacement Bond):
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: ________________
1/12/2009
Page 2 of 2