HomeMy WebLinkAboutFilled Security Bond Document (2)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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1 Verizon Way
Verizon Wireless
4700 Exchange Ct. Boca Raton, FL 32667
704-681-1805
375 E. Midway Road
3403-502-0055-020-3
Verizon Wireless
704-681-1805
2201-0283
09127991
FL VZW Amendments - SBA MIDWAY ROAD - 268221 - 16232575
Basking Ridge, NJ, 07920
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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704-681-1805