893 Amberjack Ln RES24-0285 Tree Vegetation AffidavitTREE & VEGETATION AFFIDAVIT
City of Atlantic Beach
Community Development Department
800 Seminole Road Atlantic Beach, FL 32233
(P) 904-247-5800
ADDRESS
BLOCK LOT
RE#
NAME
OWNER LEGAL AUTHORIZED AGENT
SUBDIVISION
ADDRESS
PHONE #
CELL #
EMAIL
SITE INFORMATION
CITY STATE ZIP CODE
RESIDENTIAL COMMERCIAL OTHER
APPLICANT INFORMATION
I 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 right-of-way.
TREE AND VEGETATION AFFIDAVIT 11.26.2024
FOR INTERNAL OFFICE USE ONLY
PERMIT# ___________________
**Please submit form in person
or to buildng-dept@coab.us
"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."
DATEPRINT OR TYPE NAME OF APPLICANTSIGNATURE OF APPLICANT