320 11th Street TREE20-0017 FINALTREE REMOVAL PERMIT APPLICATION
City of Atlantic Beach
Community Development Department
800 Semin o le Road Atlantic Beach, FL 32233
(PI 904 -247-5800
FOR INTERNAL OFFICE USE ONLY
INSTRUCTIONS
1. Complete and sign this application.
2. Attach required exhibits as li sted on application checklist.
3. Contact the Community Development Department if you have questions.
FILE #
o LegacyTree
o Single-/Two-Famll y Re sidential
o Multi -Family Residential
o Commercial /Industrial
$ 25.00
$125.00
$250.00
$250.00 4. Submit the completed application and aU required exhibits, along w ith
applicati o n fees to the Permits Desk at Atlantic Bea ch City Hall. o Institutional ! Other Non-Residential $250.00
SITE INFORMATION
ADDRESS 320 \ \""" ST
SUBDIVISION 5-('4 1(.-2S -,",,2-'1
RE ' jfOOG,'5 -0000
BLOCK # l-:' --'-"'------LOTI 5"
APPLICANT INFORMATION
NAME E-r (c... Gr, ~S I C~'Pj Co~f\.<F EMAIL
ADDRESS ____________ CllY ______ ST ATE ZIP COD E ___ _
CELL' '1 d<-/ 5GB 4 0+'10 PHONE II ------D OWNER ~ LEGAL AUT HORIZ ED AGENT
TREE REMOVAL PERMIT APPLICATION PACKAGE CHECKLIST
PLEASEATIACH T HE FOLLOWING EXHIBITS:
*Addltional information may be required, depending upon circumstances unique to individual applicatio ns
o EXHIBIT A (Option 1)· PROOF OF OWNERSHIP: Cop y of War ran ty Deed that ve rifies record of owner (Clerk of Co urts)
;g( EXHIBIT A (Option 2) -LETTER OF AUTHORIZATION: Please complete if the applicant is not the owner,
o EXHIBIT B -TREE INVENTORY and TREE PROTECTION PlAN r"I
o EXHIBIT C-TREE MITIGATION WORKSHEET JA:-.,;", ~ .. r ~~ --r;:""-,,<h ,,,
o EXHIBIT 0 -TREE MITIGATION PLAN
SITE PREPARATION CHECKLIST
/ PLEASE PREPARE YOUR SITE AS FOLLOW S:
~ Markall trees Identified for removal w ith RED or ORANGE flagging, paint or tape
o ;Mark all trees identified for preservation wi th BLUE or GREEN flagging , pain or tape
[JI Mark property corners with stakes or paint
o Barricade all tree s to be preserved on the property at the dripline
I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IN THIS APPLICATION IS CORRECT. I AGREE TO COMPLY WITH ALL
PROVI OF C R 23 (PROTECTION OF TREES AND NATURAL VEGETATION) AND ALL OTHER APPliCABLE CODES AND
ORDI ANC 5 OF HE TV OF AnANTIC BEACH.
PRORPENAME DATE
02 TREEREMO LPERM ITAPPLICAT/ON03.01.2018
TREE20-0017
EXHIBIT A: LEITER OF AUTHORIZATION
City of Atlantic Beach
Community Development Department
800 Seminole Road Atlantic Beach, FL 32233
(PI 904-24 7-5800
OWNER INFORMATION
FOR INTERNAL OFFICE USE ONLY
PERMIT#
NAME __ ~&f~I~~~G~(~rj~5~>~ ________________________ _ PHONE # ___________ __
ADDRESS ___ '1L~",2=---,-,1 S!..lt-----'/.J"---'¥-'t"-·--"'C,()"""2-~ _________ CEL L # _______ __
CITY __ ~:r-Ji:iKL""-..,'"''''',,''''''''''-~\o'''''______''Bee<h='''__'_ ________ _ STATE fk ZIP CODE 322.50
AGENT IN FORMATION
PHONE # _____________ _ NAME ().,;".1 Q",o.if / fltl'U SN(~
ADDRE SS ___ 5-'-:2-'=-9L'>..:>---'.C-'Q.""-2 ..... Q~9L...SL-_________ __ CELL # <td 5e e 44 'jd
ZIP CODE 321:l 'f} CITY " /1 (" STATE .c; _~b~r~~~~UN~~~.u.~~(~~~$~_______ IV
\ is hereby authori ze d to act on behalf of
eel c., GGjJ' the owner(s) of those lands described
in t he attached app li cation and as described in the attac hed d eed or other such p roof of ownership as may be required
i n applying to the City of Atlantic Beach, Florida, for an application related to a Tree and Vegetation Removal Permit.
I HEREBY CERTIFY THAT ALL INFO~RM~AT1~O~N~P~R~O~V~'D~E~D~I~S5.C~O~R!!lR!JE~'~:"<1rreeCCO;n;;prroo1>pe .. rti)yiD1 ..... u:£!;)~or Authorized Agent
Q.'-'!.-AI(~ ~, Per",~ t{It,sS,,\t<¥\
'S"'IG~N~ATTU~R~E70~F70 .. W"'NrtEOR--~~----------PRINT OR TYPE NAME OAT
SIGNATURE OF OWNER #2 PRINT OR TYPE NAM E DATE
Si g ned and sworn before me o n this _____ day of _____________ ~ ______ b y State of _____________ _
Co un ty of ___________ __
Id en tification verifi ed: _________________________________________ __
Oa t h Sworn: D Yes D No
Nota ry Signature
My Comm ission expires _____________________ _
02 TREE REMOVAL · EXHIB IT A: Letterof Au th orization 03.01.2018
A exHm,,", "''' """NTO<' ~"ROT<CTION 'UN
City of Atlantic Beach
. Co mmuni ty Devel opmen t Department
FOR INTERNAL OFFICE USE ONLY 800 Se minole Road Atlantic Beach, FL 32233
(P) 904-247-5800 PERM IT#
TREE INVENTORY-Ple ase sketch an inventory in the area be low o r attach a site plan s howing all exi sting trees on th e property be low
t hat are r d iameter at breast height (dbh) a nd greater. Please co mpl ete the follo w ing :
• Note the location of a ll trees t o be remo ved with an ·X· • Note the location of all trees t o be p reserved with -[ t • Number all trees and li st on EXHIBIT C: Tree Works heet • Show all existing a nd/or pro posed buil d ings
TREE PROTECTION PLAN -(If you ore doing construction on th« sitt')·Please sketch and Identify in th e area below or o n a co py of a
certified t ree survey the location of th e protec tive barricades to be Installed prior to co nstruction. Section 23-32(c) requires p rotecti ve
barricades to be installed around e ve ry tree or group o f trees to be preserved.
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PREPARED 8Y, SCALE, 1 SQUAR E = 7.'S I
02 TREE REMOVAL· EXHIBIT 8: T ret Inventory and Protection Plan 03.0 1,]0 18
A OXUDnT e m,,,"TIGmON WORK,""T
" City of Atlantic Beach
, Community Deve lopme nt Departme nt
FOR INTERNAL OFFICE USE ONLY 800 Sem inole Road Atl antic Beach, FL 32233
(P) 904-247-5800 PER MIH
Us t th e spec ies and di amete r at br east heig ht (d bh) of all tr ees identified on EX HI BIT B
10 OB H SPECIES ~X·= 'I I': ·0 "= COMMENTS (for use by City Staff) removi ng preservi ng replaci ng
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13
14
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19
20
21
22
23
24
25
02 TREE REMOVA L -EXHIBIT C: Tree Mitigation Worksheet 03.01 .201 8
A '''"''''"' TR" MmGAnON .... AN City of Atlantic Beach
Co mmunit y Deve lopme nt Departm ent
FOR INTERNAL OFFICE USE ONL Y 800 Seminole Road Atlantic Beach, FL 32233
(PI 904 -2 47-58 00 PERMIT #
Please id entify the location , species and size (c aliper in che s) of ALL tre es to be planted for mitigation cred it in the are a below or on a
separate si te pl an. Please include existing and/o r proposed buildin gs and any st re et name s for reference points.
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PREPA RE D BY: SCALE: 1 SQ UARE =
01 TREE REMOVAL · EXHIBIT 0: Tree Mitigation PIon 03.0'.2018