665 Sailfish Drive East TREE21-0046 ApplicationTREE REMOVAL PERMIT APPLICATION
City of Atlantic Beach
Community Development Department
800 Seminole Road Atlantic Beach, FL 32233
(P) 904-247-5800
PERMIT REQUIRED FOR REMOVAL
OF TREES 8 INCHES DIAMETER AT
BREAST HEIGHT AND GREATER
SITE INFORMATION
ADDRESS
APPLICANT INFORMATION
NAME
ADDRESS �(� ) U\ tS�
PHONE#
FOR INTERNAL OFFICE USE ONLY
CLASSIFICATION eVF )0-Peb 01
PERMIT # 1 ReP I - 04 44
Single- /Two -Family Residential $125.00
Iti-Family Residential $250.00
❑Commercial /Industrial $250.00
❑ Institutional /Other Non -Residential $250.00
EMAIL %.-QW0tMA0y' U)C001 j
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CITY %�} �UJ\1,L fDcac \STATE FL ZIPCODE
OWNER ❑LEGAL AUTHORIZED AGENT
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
❑ EXHIBIT B (Option 1) - PROOF OF OWNERSHIP: Copy of Warranty Deed that verifies record of owner (Clerk of Courts)
❑ EXHIBIT B (Option 2) - LETTER OF AUTHORIZATION: Please complete if the applicant is notthe owner
❑ EXHIBIT C - TREE INVENTORY / SITE PLAN
❑ EXHIBIT D - TREE WORKSHEET
I HEREBY CERTIFY THAT LL INFORMATION PROVIDED IN THIS APPLICATION IS CORRECT. I AGREE TO COMPLY WITH ALL
PROVISIONS OF CH/RR 23 (PROTECTION OF TREES AND NATURAL VEGETATION) AND ALL OTHER APPLICABLE CODES AND
ORDINANCES OF?,Ff1E CITY OF ATLANTIC BEACH.
SI
Signed and sworn before me on this
Identification verified:
Oath Sworn: ❑Yes ❑ No
R
PRINT OR TYPE NAME
day of ��`by State of
n
TONIGINDLESPERGER
°; MY COMMISSION # GG 353178
•'� EXPIRES: October 6, 2023
Bonded Thru Notary Public Underwriters
? TREE REMOVAL - PERMIT APPLIZATION 07.22.2021
Notary Signature
My Commission expires
my of
DATE
EXHIBIT A: TREE PERMITTING PROCESS
City of Atlantic Beach
Community Development Department
800 Seminole Road Atlantic Beach, FL 32233
(P) 904-247-5800
This document provides a general guide of the tree removal permitting process. Please sign the bottom of this
page to certif you have read this document and understand the permitting process.
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) 247-5847.
3. gation Assessment
• 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
5. Permit Approval/Issuance
• When the permit is approved, staff will place a sign in the yard and contact the applicant.
This sign must remain until the permitting process is complete and finaled.
• If paying for remaining mitigation, payment must be made within 7 days following the issuance of
the permit.
6. Planting Mitigation Replacement
• Mitigation must be planted within 30 days of permit issuance or prior to issuance of a Certificate
of Occupancy or Certificate of Completion.
7. Finallnspection
• 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
permitj,5,
finaled.
SIG ATUR T/ PRINT OR TYPE NAME DATE
02 TREE REMOVAL - EXHIBIT A: Tree Permitting Process 07.22.2021
EXHIBIT Be LETTER OF AUTHORIZATION
City of Atlantic Beach
Community Development Department
800 Seminole Road Atlantic Beach, FL 32233
(P) 904-247-5800
OWNER INFORMATION
NAME l� k v(,%�
ADDRESS Q)e(jS Sa( 1 �(S� 12) vl� "VC_
CITY �((V\7 � C' CLC
AGENT INFORMATION
NAME
ADDRESS
CITY
PHONE#'16V '_ra�7 `o/\,
CELL #
STATE ZIP CODE
STATE
PHONE#
CELL #
ZIP CODE
is hereby authorized to act on behalf of
the owners) of those lands described
in the attached application and as described in the attached deed or other such proof of ownership as may be required
in applying to the City of Atlantic Beach, Florida, for an application related to a Tree and Vegetation Removal Permit.
I HEREBY CE FY THAT ALL INFORMATION PROVIDED IS CORRECT: Signature of Property Owners)
`U cc - U C -Owl
SI NA WNER PRINT OR TYPE NAME DATE
SIGNATURE OF OWNER #2 PRINT OR TYPE NAME DATE
Signed and sworn before me on this day of
Identification verified:
Oath Sworn: ❑Yes ❑ No
02 TREE REMOVAL -EXHIBIT 8: Letter ofAuthorization 07.22.2021
by State of _
County of
Notary Signature
My Commission expires
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EXHIBIT D: TREE WORKSHEET
City of Atlantic Beach
Community Development Department
800 Seminole Road Atlantic Beach, FL 32233
(P) 904-247-5800
nit C� +
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List the species and diameter at breast height (don) of all trees identified on EXHIBIT C
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SPECIES
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COMMENTS (for use by City Staff)
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23
24
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1 HtE HtMUVAL - EXHIBIT D: Tree Worksheet 07.22.2021