1649 Atlantic Beach Drive - TREE AFFIDAVIT 111a F.
TREE & VEGETATION AFFIDAVIT JUN 19
City of Atlantic Beach -J
• s-) Department of Community Development
Planning&Zoning Division C3y,
800 Seminole Road Atlantic Beach,FL 32233
(P)904 247-5800 (F)904 247-5845 PERMIT#
SECTION I-APPLICANT INFORMATION 1wner(s) r• Legal Authorized Agent*
NAME OF APPLICANT I b -L V- t \. P
NAME OF COMPANY -Tot I 13}2,0- .
n JC
ADDRESS OF COMPANY IWO Cape May Ave • Ponte, V-ed rq r 3200
PHONE goy 2110139 CELL EMAIL Wegener)(Ibro h.ex ,CoM
CONTRACTOR CERTIFICATION NUMBER G eiC.1 51 0225
ATLBCH BUSINESS TAX RECEIPT NUMBER
SECTION II-SITE INFORMATION
STREET ADDRESS OF PROPERTY 1(1 4(1 All(Antic VJPQC Drive A ha il-it ectch. FL. 32233
If an address has not been assigned to this property,contact the AB Building Department at(904)247-5826 to request an address.
LEGAL DESCRIPTION leq brill 6ar(,y1 eo it i j club 1Anit2 ,(p�-X32 ( -2-- 2'1E
LOT 0) BLOCK 13 J SUBDIVISION Ala yll-i �( .b
J
REAL ESTATE NUMBER LOT OR PARCEL SIZE: ' J,zoo SQ FT AC
RESIDENTIAL )C COMMERCIAL OTHER(SPECIFY)
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,FL and/or I have participated in a pre-application meeting with the Administrator of those
regulations. Subsequently,I affi .• that no regulated trees and no regulated vegetation will be damaged,destroyed and/or removed
from the above-described• •dja•-nt properties in conjunction with this project.
SIGNATUR• OF OW SIGNATURE OF OWNER
Signed and sworn before me on this I c.\day of 3 .� , 20 ,by State of
S+�Q (' A€ t" County of
Identification verified: RasoJl.
MELISSA LIEBERMAN
Oath sworn: IV/Yes r' No _ • MY COMMISSION='FF055605
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o EXPIRES September 18.2017
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(407) yt)•u i o3 FI.ideNetary6orvico coo,
Notary i nature
REV-TVA-v,0.12 My Commission expires: q I I ii