HomeMy WebLinkAbout11825_FHP Substation-Security Bond Affidavit v.0Building and Code Regulations Division
Permitting and Zoning
2300 Virginia Ave
Ft. Pierce, F134982
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: Verizon Wireless
2. Address: _7701 Telecom Parkway
Tampa. FL 33637
Phone Number: _410-952-3860 — Paul Bailey/Agent_ Fax Number:
3. Location of Tower (Address): 2929 N 25th St, Ft. Pierce 34946
4. Parcel Identification Number: 1429-501-0018-000-7
5. Lease Holders Name & Address: Tr Int Trust Fund
3900 Commonwealth Blvd.
Phone Number:
Tallahassee. FL 32399
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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Cash, Security Fund, Irrevocable Letter of Credit or Bond to Secure Prior
Service Provider Information (If Replacement Bond):
1. Name:
2. Address:
Phone Number:
3. Location of Tower (Address):
4. Parcel Identification Number:
5. Lease Holders Name & Address:
Phone Number:
Fax 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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