650 Orchid Street DRTV12-00100038 ApplicationTREE & VEGETATION REMOVAL, PERMIT APPLICATI®N
INSTRUCTIONS
(1) Complete and sign this form.
(2) Attach the required supporting exhibits as listed on the application
checklist.
(3) Contact the Department of Community Development if you have
questions or need assistance completing the application or
determining which exhibits are required for your particular project.
(A) Submit this form, along with all required exhibits and payment to
the City of Atlantic Beach, and in the appropriate amount according
to the application fees listed to the right, to the reception desk at
the Building Department.
SECTION I - SITE INFORMATION
City of Atlantic Beach
Department of Community Development
.� 800 Seminole Road Atlantic Beach, FL 32233
(P) 904 247-5800 (F) 904 247-5845
Via_
ingle- /Two -Family Residential $125.00
j— Multi -Family Residential $250.00
f— Commercial / Industrial $250.00
F_ Institutional /Other Non-residential $250.00
Application #TREE 12
PHYSICALADDRESS s ( A-` /4tO-fe t a„
If on address has not been assigned to this property, contact the AB Building Department at (904) 247-5826 to request on address.
SUBDIVISION J31/q c (f BLOCK 12 LOT RE # i 70'7'�>7
SECTION II - APPLICANT INFORMATION X OWNER j— LEGAL AUTHORIZED AGENT
NAME OF APPLICANT bvI4,r,eof 0, P ./Z - 4.1Hdir�
ADDRESS OF APPLICANT %,�_ 71 Ay ,-4,j,-Yi4 e 4eA F4
PHONE f �� CELLv� !j / 71
EMAIL
( / r2 r l':e)
SECTION III - TREE & VEGETATION REMOVAL REQUEST
I REQUEST THAT THE TREES & VEGETATION ON THE ABOVE DESCRIBED PROPERTY AND INDICATED ON THE ATTACHED REQUIRED
EXHIBITS BE APPROVED FOR REMOVAL, AS PROVIDED IN THE CITY OF ATLANTIC BEACH VEGETATION CODE, CHAPTER 23, FOR THE
FOLLOWING REASONS (check all that apply):
F- Vegetation (trees) are difficult to maintain /owner dislikes.
F— Trees are dead, diseased or so weakened by age, storm, fire, or other injury so os to pose a danger to persons, property,
improvements or other trees.
F- Vegetation (trees) pose a safety hazard to pedestrian or vehicular traffic or cause disruption to public utility services.
r— Vegetation (trees) pose a safety hazard to buildings or structures.
F- Vegetation (trees) completely prevent access or cross access to a lot or parcel.
Vegetation and/or trees prevent development or physical use. It is the intent of this provision that a permit shall be granted for
the removal of vegetation and/or trees when the applicant has demonstrated an effort to design or locate the proposed
improvements so as to minimize the removal of vegetation and/or trees.
1 HEREBY CERTIFY THAT ALL INFORMATION PROVIDED WITHIN THIS APPLICATION IS CORRECT AND 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.
SIGNATURE
DATE
FOR INTERNAL OFFICE USE ONLY
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