893 AMBERJACK LN RES24-0285 tree vegetation affidavit_1-15-25} TREE & VEGETATION AFFIDAVIT
City of Atlantic Beach
Community Development Department
th
800 Seminole Road Atlantic Beach, FL 3.22.33
s gw (P) 904-247-5800
SITE INFORMATION
ADDRESS 9"7;
SUBDIVISION "Vk
RE# 11111f-0000
APPLICANT INFORMATION
NAME
ADDRESS
P1
7_ Mn
rg, RESIDENTIAL
FOR INTERNAL OFFICE USE ONLY
PERMIT# IZE,52!�-QZ95
"Please submit form in person
or to huildngwdept@coab.us
BLOCK ¢ LOT
❑ COMMERCIAL ❑ OTHER
PHONE#
CELL # �7,9 � l 6 L_ �
1.
CITY&—dolp4le—---- STATE ZIP CODE -3ZZ33
EMAIL cee� rea— co Wl OWNER ❑ LEGAL AUTHORIZED AGENT
1 affirm that I 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 fright -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."
i
SIG RE F P CANT WIN'T OR TYPE NAME OF APPLIcAINT DATE
TREEAND VEGETATION AFFIDAVIT 7 7.26.20Z4