1355 Ocean Boulevard DRTV12-00100042TREE & VEGETATION REMOVAL PERMIT APPLICATION
INSTRUCTIONS City of Atlantic Beach
_ Department of Community Development
(1) Complete and sign this form. I,; 800 Seminole Road Atlantic Beach, FL 32233
(2) Attach the required supporting exhibits as listed on the application `! (P) 904247-5800 (F) 904 247-5845
checklist.
(3) Contact the Department of Community Development if you have FI�ngle-/Two-Family Residential $125.00
questions or need assistance completing the application or
determining which exhibits are required for your particular project. Multi -Family Residential $250.00
(4) Submit this form, along with all required exhibits and payment to r Commercial / Industrial $250.00
the City of Atlantic Beach, and in the appropriate amount according
to the application fees listed to the right, to the reception desk at r Institutional /Other Non-residential $250.00
the Building Department. r
Application # TREE �- ( i OCb 42.
SECTION I - SITE INFORMATION
PHYSICALADDRESS 135 �Ge/Va — 4�-IaaZ
If an address has not been assigned to this property, contact the AB Building Department at (904) 247-5826 to request an address.
SUBDIVISION �a y�( I(� BLOCK 53 LOT g RE #
SECTION 11- APPLICANT INFORMATION j—V-O--W'
NER r LEGAL AUTHORIZED AGENT
NAME OF APPLICANT L)A_)6L E4r-) /ULG3EY�!
ADDRESS OF APPLICANT
PHONE CELL 907 -�3 +� EMAIL !i r i Gjyl
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):
j-" Vegetation (trees) are difficult to maintain /owner dislikes.
�- Trees are dead, diseased orso weakened by age, storm, fire, or other injury so as to pose a danger to persons, property,
improvements or other trees.
Vegetation (trees) pose a safety hazard to pedestrian or vehicular traffic or cause disruption to public utility services.
F- 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
I �' 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.
I HERE CERTIFY THAT ALL INFORMATION PROVIDED WITHIN THIS APPLICATION IS CORRECT AND 1 AGREE TO COMPLY
WITH LL PROVISIONS QF CH PTE 23, PROTECTION OF TREES AND NATURAL VEGETATION, AND ALL OTHER APPLICABLE
COD AND ORDI ANC�ES OF HE ATLANTIC BEACH.
A// 'v /a
SIGNA R CAVY DATE
FOR INTERNAL OFFICE USE ONLY
FRONTAGE _0Y) 1 FLU 1;2) L ZVAR ESA SR -I 117141ZDG z7
DEPTH Z6.,,, t' ZONING I?_S 2— UBEX H/H _LA�ec-, SR -2 /
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Tree & Vegetation Removal Permit Applica ti on_versionoi. oi. og
f - ;, EXHIBIT A. LETTER OF AUTHORIZATION Application # TREE 2- 6010 `
be required by the City of Atlantic
BY: /
is hereby authorized to act on behalf of
the owner(s) of those lands described within
d in the attached deed or other such proof of ownership as may
in aTplyi for a development permit.
Signature of Owner -
Printed Name
Signature of Owner
Printed Name
Mailing Address
Phone Cell Email
/���y� /% O% b State y f Florida
Signed and sworn before me on this day of C y Count of Duval
Lin1DLE� %of�T
��J /� MARIA PIMIENTA
Identification verified: (JvYWL� % f���L�Y� '� = Notary Public - State o1 Florida
' dfMy Comm. Expires Jan 28.2015
Oath sworn: 7 Yes r No �a��aF�d�.� Commission # EE 59080
My Commission expires:
EXHIBITA_Letter ofAuthorization_versionoi.oi.o9
Mailing Address
Phone
Cel Email
Signature of Owner
Printed Name
Mailing Address
Phone Cell Email
/���y� /% O% b State y f Florida
Signed and sworn before me on this day of C y Count of Duval
Lin1DLE� %of�T
��J /� MARIA PIMIENTA
Identification verified: (JvYWL� % f���L�Y� '� = Notary Public - State o1 Florida
' dfMy Comm. Expires Jan 28.2015
Oath sworn: 7 Yes r No �a��aF�d�.� Commission # EE 59080
My Commission expires:
EXHIBITA_Letter ofAuthorization_versionoi.oi.o9
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MAP OF SURVEY
LOTS 7 AND 8, BLOCK 53, MANDALAY, AS RECORDED IN PLAT BOOK 10, PAGE 11
OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA
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THIS IS A BOUNDARY SURVEY.
BEARINGS BASED ON THE EAST RIGHT OF WAY LINE OF
OCEAN BOULEVARD AS BEING N05°37'00"W AS PROJECTED
FROM PLAT OF ATLANTIC BEACH PARKWAY UNIT No. 2,
PLAT BOOK 15, PAGE 83.
NO BUILDING RESTRICTION LINES PER PLAT.
THE PROPERTY SHOWN HEREON LIES
} T "X" (AREA OUTSIDE 500 YEAR FLOOD PI
THE FLOOD
SITE PLAN
a0' RIG 3LhAYSTREEPAVED IC ROAD COMMUNITY PANDETERMINEDOErL NUMBER 12200 5UOC
APRIL 17, 1989 FOR THE CITY OF ATLAI\
! — DUVAL COUNTY, FLORIDA.
DEAN NC. ALL. ZGIJTS 2ESERVED. NO PAZT OF TU- \V021C MAY 6E USED. DCGPODUCED. DLSTQeuTED. DLAPLAYED OR OT1 BIZ\VLS CONI }WATED N
ANY FSM aR by ANY ngEaNs \VlTilouT PwoQ \VwTTEN CON --CN