HomeMy WebLinkAbout5800245 2112-0523 Security Bond Document
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: AT&T Mobility
2. Address: 3210 Lake Emma Road Lake Mary, FL 37246
Phone Number: ________________ Fax Number: 407-771-1398
3. Location of Tower (Address): 5041 St. Lucie Blvd. Fort Pierce, FL 34996
4. Parcel Identification Number: 1431-211-0001-000-2
5. Lease Holders Name & Address: Crown Castle, USA
4511 North Avenue, Ste 210
Tampa, FL 33614
Phone Number: 813-519-9320 Fax Number: ______________
6. ID Number of Bond, Irrevocable Letter of Credit or Check: 674021315
7. Permit Number of Tower, Antenna or Antenna Array: 2112-0523
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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: __________________ 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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