1296 Beach Ave TREE25-0050 8.3.25 SC TREE REMOVAL PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
1' City of Atlantic BeachCLASSIFICATION FEZ
1 Community Development Department
"~ 800 Seminole Road Atlantic Beach,FL 32233 PERMIT#
r�un y;- (P)904-247-5800 -
PERMIT FEES
Single-/Two-Family Residential $125.00
PERMIT REQUIRED FOR REMOVAL - ❑ Other $250.00
OF TREES 8 INCHES DIAMETER ATJ - — -
BREAST HEIGHT AND GREATER Please submit form in person
or to buildin9-dWt@coaK.us
SITE INFORMATION 1_ l
ADDRESS
APPLICANT INFORMATION
NAME r `-�h ❑ OWNER LEGAL AUTHORIZED AGENT
ADDRESS �q Pq�s ,,�� CITY &10^4 STATE ZIP CODE
PHONE# qL( q(�;a EMAIL bS?iahi�'ItRCl�irhb t� � •
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REASON FOR TREE REMOVAL
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TREE REMOVAL PERMIT APPLICATION PACKAGE CHECKLIST
PLEASE ATTACH THE FOLLOWING EXHIBITS:
*Additional information may be required,depending upon circumstances unique to individual applications
❑ EXHIBIT A-TREE PERMITTING PROCESS
i
❑ 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
❑ EXHIBIT C-TREE INVENTORY and SITE PLAN
❑ EXHIBIT D-TREE WORKSHEET
I 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
ORDINANCES OF THE CITY OF ATLANTIC BEACH.
1'
SIGNATURE OF OWNER or AGENT 1 PRINT OR TYPE NAME DATE
Signed and sworn before me on this T day of ZOZr by State of ♦d� 'c��
9,4iR County of rbu,r�
Identification verified:
Oath Sworn: aYes ❑ No —
;otii3'Y ov'• GUILLERMO RIOS Notary Signature
'_'Z Notary Public•State of Florida
; �� Commission k HH 458170 M Commission ex ires !�/�Z ZO
OF.f`� My comm.Expires Nov 2,2027 y p
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TREE REMOVAL PERMITAPP - .
EXHIBIT A: TREE PERMITTING PROCESS
City of Atlantic Beach
r Community Development Department
800 Seminole Road Atlantic Beach,FL 32233
ru i19' (P)904-247-5800
This document provides a general guide of the tree removal permitting process. For complete information on
permitting procedures see Section 23-23. Please sign the bottom of this page to certify that you have read this
document and understand the permitting process.
�"EORE PERMIT ISSUANCE
1. Submit Completed Application
• All trees on property must be labeled on Exhibits C and D.
2. Schedule Inspections
• All trees to be removed must 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) 247-5822.
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 include a site plan, proposed species,and size(s). Plans must account
for all inches owed.
• A MITIGATION PLAN MUST BE SUBMITTED AND APPROVED PRIOR TO REMOVAL OF IDENTIFIED TREES.
AFTER PERMIT ISSUANCE;
S. 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.
SIGNATUR OF APPLICANT PRINT OR TYPE NAME OF APPLICANT DOE
TREE REMOVAL PERMITAPPLICATION-EXHIBIT A:Tree Permitting Process 06.24.2025
EXHIBIT B: LETTER OF AUTHORIZATION
City of Atlantic Beach
Community Development Department
1 ~� 800 Seminole Road Atlantic Beach,FL 32233
(P)904-247-5800
lease complete if applicant is not the owner
OWNERFFIlINFORMATIO A _- --
NAME yK�� �� I1_�L �_�ifs PHONE# 47ASLi-D&47
ADDRESS EMAIL
CITY � STATE F1, ZIP CODE
AGENT INFORMATION
n 5 C �p ^�
NAME ; j h PHONE# �'�_ -_E) t& ,q f o�
ADDRESS aS fS Rce,,5 D!-tyz: Loa+ EMAIL Cayi,+w,n��; �C �,yhbs Can .
CITY Y. C r,C' STATE ZIP CODE
I 7 i aft �_CY]A is hereby authorized to act on behalf of
AnY1�,i f,y)n e f� e i n 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 Beach,for an application related to a Tree and Vegetation Removal Permit.
I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT:Signature of Property Owner(s)
SIGNATURE OF OWNER �' PRINT OR TYPE NAME DATE
'W�l A -7/01S/e;�5
/ � �U
SIGH ATURE F'ZIWNER#2 P INT TYPE NAM DATE
+ ` ' \
Signed and sworn before me on this � � day of. � � by State of
l County of 0
voj
Identification verified:
Oath Sworn: ❑ Yes ❑ No
Notary Signature
My Commission expires _
TREE REMOVAL PERMIT APPLICATION-EXHIBIT B:Letter of Authorization 06.24.2025
s=�'1 EXHIBIT C: TREE INVENTORY and SITE PLAN
JId City of Atlantic Beach
Y Community Development Department FOR INTERNAL OFFICE USE ONLY
V~ 800 Seminole Road Atlantic Beach,FL 32233
�± CLASSIFICATION
f,;is9' (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:
• 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"O" i Show all existing and/or proposed buildings
® Number all trees and list on EXHIBIT D:Tree Worksheet
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PREPARED BY: SCALE:1 SQUARE=
TREE REMOVAL PERMIT APPLICATION-EXHIBIT C:Tree Inventory and Site Plan 06.24.2025
rt ,, EXHIBIT D: TREE WORKSHEET
= '' City of Atlantic Beach
of Community Development Department
800 Seminole Road Atlantic Beach,FL 32233
o;31�r (P)904-247-5800
List the species and diameter at breast height(dbh)of all trees identified on EXHIBIT C(attach additional pages as needed).
'removing ID DBH SPECIES preserving relocating
` COMMENTS(for use by City Staff)
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TREE REMOVAL PERMITAPPLICATION-EXHIBIT D:Tree Worksheet 06.24.2025