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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: _______________
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VERIZON WIRELESS
4700 EXCHANGE CT, BOCA RATON, FL 32667
916-385-4266
10600 S Ocean DR, Jensen Beach, FL 34957
4511-517-0000-000-8
VERIZON WIRELESS
4700 EXCHANGE CT
BOCA RATON, FL 32667
916-385-4266
09127990
2106-0620
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
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