893 AMBERJACK LN RES24-0285 tree vegetation affidavit 2-11-25TREE & VEGETATION AFFIDAVIT
City of Atlantic Beach
Community Development Department
7. 800 Seminole Road Atlantic Beach, FL 32233
(P) 904-247-5800
SITE INFORMATION
ADDRESS 893 Amberjack Lane
SUBDIVISION Roval Palms
RE# 171178-0000
APPLICANT INFORMATION
NAME Charles Lundgren
ADDRESS 893 Amberjack Lane
FOR INTERNAL OFFICE USE ONLY
PERMIT# /��Sz-P'M-57
"Please submit Form in person
or to buildng-dept@coab.us
BLOCK 4
LOT 24
0 RESIDENTIAL ❑ COMMERCIAL 0 OTHER
PHONE#
CELL # 904 962 9575
CITY Atlantic Beach STATE FL ZIP CODE 32233
EMAIL ceebreez@hotmail.com
OWNER 0 LEGAL AUTHORIZED AGENT
I affirm that 1 have reviewed the provisions of Chapter 23, "Protection of
Trees and Native Vegetation", of the Municipal Code of Ordinances for the
City of Atlantic Beach Florida and/or I have participated in a pre -
application meeting with the Administrator of those regulations.
Subsequently, I affirm that no regulated trees and no regulated vegetation
will be damaged, destroyed and/or removed from the above-described
property and/or adjacent properties including right-of-way.
"In lieu of signed, sworn and notarized signatures of the property owner, agent and/or contractor, and under penalties of
perjury, I declare that I have read and examined the foregoing application and that the facts stated in it are true and correct."
V,//, 1'6�4
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G%4&� Charles Lundgren 12-12-2024
4 r24 J�iE OF APPLI T IfPRINT OR TYPE NAME OF APPLICANT DATE
TREEAND VEGETATION AFFIDAVIT 11.26.20. 4