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Home My WebLink AboutADAMS RANCH_237546_16280499_Security Bond Info Form_10-13-2021 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 Fidelity and Deposit Company of Maryland 3910 Keswick Rd Baltimore Maryland 21211 (847) 605-6000 21715 Orange Avenue Fort Pierce FL 34945 2208-311-0001-000-6 Verizon Wireless 14055 Riveredge Dr Suite 600 Tampa FL 33637 8138480270 08985519 2109-0316 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