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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 vi c P o EXPIRES September 18.2017 i I Y1 (407) yt)•u i o3 FI.ideNetary6orvico coo, Notary i nature REV-TVA-v,0.12 My Commission expires: q I I ii