1804 Selva Grande Drive TREE25-0028 04.25.2025 SC TREE REMOVAL PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
City of Atlantic Beach
CLASSIFICATION
Community Development Department
800 Seminole Road Atlantic Beach,FL 32233 PERMIT#
! ;i»f (P)904-247-5800
PERMIT FEES
, ® Single-/Two-Family Residential $125.00
PERMIT REQUIRED FOR REMOVAL a d& ® Other $250.00
OF TREES 8 INCHES DIAMETER AT "' s
* Please submit form in person
BREAST HEIGHT AND GREATER or to buildng-dept@toab.us
SITE INFORMATION
ADDRESS 1804 Selva Grande Drive Atlantic Bch.FL 32233
APPLICANT INFORMATION
NAME Stella Knieriemen F� OWNER QX LEGAL AUTHORIZED AGENT
ADDRESS 76 Levy Rd. CITY Atlantic Beach STATE FL ZIP CODE 32233
PHONE# (904)662-5588 EMAIL stella@poolsbystella.com
REASON FOR TREE REMOVAL
TREE REMOVAL PERMIT APPLICATION PACKAGE CHECKLIST
PLEASE ATTACH THE FOLLOWING EXHIBITS:
*Additional information may be required,depending upon circumstances unique to individual applications
F EXHIBIT A-TREE PERMITTING PROCESS
EXHIBIT B(Option 1)-PROOF OF OWNERSHIP:Copy of Warranty Deed that verifies record of owner
EXHIBIT B(Option 2)-LETTER OF AUTHORIZATION: Please complete if the applicant is not the owner
Fx EXHIBIT C-TREE INVENTORY and SITE PLAN
EXHIBIT D-TREE WORKSHEET
1 HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IN THIS APPLICATION IS CORRECT. I AGREE TO COMPLY WITH ALL
PROVISIONS OF CHAPTER 23(PROTECTION OF TREES AND NATURAL VEGETATION)AND ALL OTHER APPLICABLE CODES AND
OJAN OF THE CITY OF ATLANTIC BEACH.
Stella Knieriemen
SIGN RE OF OWNER or AGENT PRINT OR TYPE NAME DAT
Signed and sworn before me on this \�-\5"day ofby State of
County ofj�44�.�_
Identification verified: `
Oath Sworn: Xy
es No
StJ�Y FUB
r°.•••••.`'o WESTON SMITH Nota tg ture
* * Commission#HH 453945
Expires October 12,2027 My Commission expires Cc:L{:mom \-'
TREE REMOVAL PERMITAPPLIC477ON 03.15.2024
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l EX"IBIT TREE PERMITTING
.
City of Atlantic Beach
'01-
K Community Development Department
\ 800 Seminole Road
Atlantic Reach, L 32233
ry }8 (P)904-247.5800
This document provides a general guide of the tree removal permitting process. For complete information on
permitting procedures see Section -23. Please sign the bottom of this page to111C:�y�� that,you have read this
docu ent and understand theer ittin process.
p
BEFU'0"hRE PL�RMIT ISSU/mAsU&NE '&�E
1. Submit Completed Application
9 All trees on property must be labeled on Exhibits C and D.
2. Schedule inspections
* All trees to be removed ust be labeled with red or orange tape or ribbon and numbered per Exhibit C.
• If there is construction on property,a barricade inspection will also be done at this time.
Call for more information at(904)247-5847.
3. Mitigation Assessment
• Mitigation shall be in the form of preservation or relocation of existing trees, replacement with new trees or
payment into the tree fund. See Section 23-33 for more information.
• Staff will review the trees proposed for removal and send the applicant a Tree Permit Calculations sheet
which outlines mitigation that is owed.
4. Proposed Mitigation Replacement Plan
�► Submit a mitigation replacement plan within 30 days of receiving the mitigation calculations.
• The proposed plan must inctu e a site pian, proposed species,and size(s). Plans must account
for all inches owed.
A MITIGATION PLAIN MUST BE SUBMITTED AND APPROVED PRIOR TO REMOVAL of IDENTIFIED TREES.
AFTER PERMIT ISSUANCE
. Permit Issuance
When the permit is approved,staff will place a sign in the yard and contact the applicant.This sign must
remain until the permit is finaled.
® If paying for mitigation,payment must be made within 7 days following the issuance of the permit.
6. Mitigation Replacement
Replacement trees must be planted within 30 days of permit issuance or prior to issuance of a Certificate of
Occupancy or Certificate of Completion.
7. Final Inspection
• After trees are planted and/or construction is complete,a final inspection must be scheduled.
�► Trees planted, preserved and relocated must survive three(3)years following the date the permit is finaled.
SIGNATURE OF APPLICANT PRINT OR TYPE NAME DA
TREE REMOVAL PERMIT APP'LICATI N-EXHIBIT A:Tree Permitting Process 03.a 5..2024
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EXHIBIT B: LETTER OF.AUTHOIZATI N
Cit Of Atlantich
�z � Beach
� Community Development Department F
800 Seminole Road Atlantic Beach® FL 32233
�. (P) 904-247-5800 IN
Q
�.d
"Please complete if applicant is not the owner
F
OWNER INFORMATION
a
NAME �c k VAie PHONE# d L_ 9�S!3 Z.
ADDRESS gL EMAIL
CITY STATE ZIP CODE
AGENT INFORMATION
NAMES"6= )rjal .� ,6Af APHONE#
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ADDRESSSQlAtAng. k_%a 0.-EMAIL 0 moo, .
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CITY Age, STATE � ZIP CODE
is hereby authorized to act on behalf of
L10, �` the owner(s) of those lands described
in the attached application and as described in the attached warranty deed or other such proof of ownership as may
be required in applying to the City of Atlantic Reach®for an application related to a Tree and Vegetation Removal Permit.
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HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT:Signature of Property Owner(s)
SIGNA R F OWIqER PRINT OR TYPE NAME DAT
S TUBE OF OWNER#2 PRINT OR TYPE NAME DATE
Signed and sworn before me on this day of by State of
` County of
Identification verified:
Oath Sworn: Yes No
.°,,°•._.��� WESTON SMITH
* Commission#HH 453945
Notary Signature
Expires October 12,2t�27
OFF My Commission expires ��.
TREE REMOVAL PERMIT APPLICATION®EXHIBIT B:Letter ofAuthorization 03.15.2024
s = EXHIBIT C: TREE INVENTORY and SITE PLAN
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City of Atlantic Burch
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Community Development Department FOR INTERNAL OFFICE USE ONLY
800 Semilnole Road Atlantic Beach,FL 32233
CLASSIFICATION
(P)904-247-5800
PERMIT#
TREE INVENTORY-Please sketch an inventory in the area below or attach a site plan showing all existing trees on the
property below that are 8"diameter at breast height(dbh)and greater.Please complete the following:
W show the location of all trees to be removed with an"X" • Show the location of all trees to be preserved with
• Show the location of all trees to be relocated with an' "a" * Show all existing and/or proposed buildings
i Number all trees and list on EXHIBIT D:Tree Worksheet
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TREE REMOVAL PERMIT APPLICATION-EXHIBIT C.Tree Inventory and Site Plan 03.15.20.24
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EXHIBIT D:TREE WORKSHEET
City of Atlantic Beach
(V9 I'll, .
Community Development Department
$00 Seminole Road Atlantic �`a �.32233
P 904-247-5800
List the species and diameter at breast height(dbh)Of all trees identified On EXHIBIT C(attach additional page as needed),
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TREE REMOVAL PER IT"APPLICAT ION-EXHIBIT :Tree Worksheet 03.15.20.24
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