Tree Permit Application
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1
2Tree Protection
Tree Relocation
Tree Removal
Land Clearing/Grubbing
Demolition
1. Date of Application:____/____/____
Tax Folio #:______-___-______Application #:________-____________
2. Property Owner’s Name:_______________________________________________________________________
Owner’s Address:________________________________City:__________________State:_______Zip________
Owner’s Phone:(_____)_______-__________Owner’s Email:_________________________________________
3. Contractor:__________________________________________________________________________________
Certificate of Competency #:_______________________________State Registration # :____________________
Contractor Address:_______________________________City:__________________State:_______Zip________
Contractor Phone:(_____)_______-________Contractor Email:________________________________________
4. Description of Work:__________________________________________________________________________
Job Address:_________________________________________________________________________________
Subdivision:__________________________________________________Block:____________Lot:__________
5. Engineer: ___________________________________________________________________________________
Engineer Address:_______________________________City:__________________State:_______Zip________
Engineer Phone:(_____)_______-__________Engineer Email:_________________________________________
6. Architect:___________________________________________________________________________________
Architect Address:_______________________________City:__________________State:_______Zip________
Architect Phone:(_____)_______-__________Architect Email:________________________________________
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
7.
Affidavit: Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that all work or installation
will be performed to meet the standards of all laws regulating construction in the City of Pompano Beach. I certify that all the forgoing
information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning.
Signature of Legal Owner/Agent:
Signature of Legal Contractor:
Including Contractor with
notarized statement.
X______________________________________
X______________________________________
STATE OF FLORIDA - COUNTY OF BROWARD
STATE OF FLORIDA - COUNTY OF BROWARD
Sworn to (or affirmed) and subscribed before me
Sworn to (or affirmed) and subscribed before me
this_________ day of ________________, 20________ by
this_________ day of ________________, 20________ by
__________________________________
__________________________________
(Type / Print Owner’s Name)
(Type / Print Owner’s Name)
_______________________________________
_______________________________________
NOTARY’S SIGNATURE
NOTARY’S SIGNATURE
as to Owner or Agent’s Signature
as to Owner or Agent’s Signature
_______________________
_______________________
Name & Title (printed)
Name & Title (printed)
(Type / Print Notary’s Name)
(Type / Print Notary’s Name)
Personally Known ________or Produced ID__________
Personally Known ________or Produced ID__________
:_________________
:_________________
Type of Identification Produced
Type of Identification Produced
__________________________________
__________________________________
Revision Date: 2/21/14
Page 1 of 2
G:/Zoning 2009/Zoning
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