Construction Services Division
1400 N. Boulevard
Tampa, FL 33607
Phone:(813) 274-3100
Fax: (813) 259-1712
www.tampagov.net/permits
Tree Removal and Site Clearing
Statement
Section 1Section 2
General Information
Applicant Phone #
Submittal Date
Project #
Project Address
I certify that the following project as checked below, together with the plans and specifications, reflects a true
representation of the proposed construction activity.
I certify that no protected trees are within twenty (20) feet of the proposed work and no protected trees are to be
removed, transplanted or trimmed. I further certify that no wetlands are within thirty (30) feet of the proposed
work.
I understand that all construction projects not withstanding this affidavit are subject to site inspections and
enforcement of tree protection standards. If upon inspection this site is found to be in violation of Chapter 13,
City of Tampa Tree and Landscape Code, a notice of violation and/or stop work order will be issued and code
enforcement procedures initiated.
Project Description
Site Lighting
Enclosure for Pool or Patio
Demolition
Handicap Ramp
Underground Utilities or Piping
Construction over Existing Paving/Concrete
Building Addition less than 500 SF (Residential Only)
Driveways or Slabs under 750SF
Loading Dock
Pool or Spa
Above or Underground Tank
Other, Please Specify:
Signature of Applicant
Date
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