0 12th Street TREE23-0056 12.12.2023 SCTREE 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
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SITE INFORMATION
ADDRESS O 12th St, Atlantic Bch, FL 32233 (Parcel# 170366-0100)
APPLICANT INFORMATION
NAME Ian Brown (trustee of ILB Revocable Trust)
ADDRESS 2165 Herschel St CITY Jacksonville
FOR INTERNAL OFFICE USE ONLY
., CLASSIFICATION _____ _.____
PERMIT# _________ _
PERMIT FEES
� Single-/ Two-Family Residential $125.00 I :
D Multi-Family Residential $250.00 Ii: D Commercial / Industrial $250.00 l ,
D Institutional / Other Non-Residential S250.0.i / : L--------------��
�OWNER
STATE
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0 LEGAL AUTHORIZED AGENT !;•• JIFL ZIP CODE 32204 I il; PHONE# 904-625-7362 EMAIL ian@yield-coach.co1m _: I 'I I
TREE REMOVAL PERMIT APPLICATION PACKAGE CHECKLIST PLEASE ATTACH THE FOLLOWING EXHIBITS:
*Additional inform ation may be required, depending upon circumstances unique to individual applications(gJ EXHIBIT A -TREE PERMITTING PROCESS�EXHIBIT B (Option 1) -PROOF OF OWNERSHIP: Copy of Warranty Deed that verifies record of owner
0 EXHIBIT B (Option 2)-LETTER OF AUTHORIZATION: Please complete if the applicant is not the owner(gj EXHIBIT C -TREE INVENTORY and SITE PLAN
(g] 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 ANO
ORDINANCES HE OF ATLANTIC BEACH.
Ian Brown PRINT OR TYPE NAME
Signed and sworn before me on this q----tfr) day of De ct'�. 2P?:3 by
::rah B1V VV n
• l\__'.' I Identification verified: yro\f '\4-d Cif\� s \ t'.'enx
12/7/23 DATE
State of f /JZf?I ))A-
County of J:)Jv/tt_ .,,
Oath Sworn: r/ves D No J If�'----. -N -ot .:fr-�--t--'i g �nj;...at -u -re _____________ _
02 TREE REMOVA L PERMIT APPL
.... Notary Public �ate of Florida g_ Mllad_y Weisenstein__....__ My Commlulon HH 225�23 �PJ 2m202e My Commission expires _�!::::J)L..T�}�2h�::::__------
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VACANT LOT
TREE23-0056
(Fax) 904-448-5178
1825 University Boulevard West
Jacksonville, Florida 32217
(Phone) 904-448-5125