HomeMy WebLinkAboutSERVICE PROVIDER INFORMATIONBuilding and Code Regulations Division
Permitting and Zoning
2300 Virginia Ave k9c
Ft. Pierce, FI 34982 !SN's
8t 44f, �&J' 6
772-462-1553 0/6
Cash Security Fund, Irrevocable Letter of Credit or Bond to Secure Cost of
Removing an Antenna, Antenna Array or Tower
Service Provider Information
I.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:
Page I of 2
. . I
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
Page 2 of 2