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INDIAN RIVER COUNTY
DEPARTMENT OF EMERGENCY SERVICES
APPLICATION FOR
CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
I. CLASSIFICATION OF CERTIFICATE REQUESTED
17-71n
Class AClass B
U X
Clajs C ❑ Class D
II. TYPE OF APPLICATION:
NEW
RENEWAL 19
LEVEL OF SERVICE
III. DATE OF APPLICATION: 11/6/00
X
APPLICATION FEE ATTACHED: YES NO
BLS ❑X
ALS ❑X
APPLICATION FEE OF $100.00 APPLIES TO INITIAL APPLICATIONS ONLY. THE APPLICATION FEE IS
WAIVED FOR CERTAIN APPLICANTS - REFER TO THE ATTACHMENT FOR INFORMATION.
If payment is applicable, the check must be made payable to INDIAN RIVER COUNTY FLORIDA