1745 Beach Avenue TREE19-0024 05.24.2019 SCri,,ayr�J TREE REMOVAL PERMIT APPLICATION
�S N;,, City of Atlantic Beach
Community Development Department
V 800 Seminole Road Atlantic Beach, FL 32233
'��J;i1Jr (P) 904-247-5800
INSTRUCTIONS
1. Complete and sign this application.
2. Attach required exhibits as listed on application checklist.
3. Contact the Community Development Department if you have questions.
4. Submit the completed application and all required exhibits, along with
application fees to the Permits Desk at Atlantic Beach City Hall.
SITE INFORMATION
ADDRESS 1745 Beach Ave., Atlantic Beach, FL 32233
SUBDIVISION 03098 NORTH ATLANTIC BCH UNIT 1 BLOCK #
APPLICANT INFORMATION
NAME Robert and Powv Clements
ADDRESS 4667 Ortega Blvd.
PHONE # (904) 281-6204 CELL #
FOR INTERNAL OFFICE USE ONLY
PERMIT#�E �00ZA
Vgacy Tree $ 25.00
ngle-/Two-Family Residential $125.00
❑ Multi -Family Residential $250.00
❑ Commercial / Industrial $250.00
❑ Institutional/ Other Non -Residential $250.00
RE# 169670-0000
LOT # LOT 30
EMAIL poppyclem@aol.com
CITY Jacksonville STATE FL ZIP CODE 32210
❑X 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 (Option 1) -PROOF OF OWNERSHIP: Copy of Warranty Deed that verifies record of owner (Clerk of Courts)
❑ EXHIBIT A (Option 2) -LETTER OF AUTHORIZATION: Please complete if the applicant is not the owner
EXHIBIT B -TREE INVENTORY and TREE PROTECTION PLAN
❑ EXHIBIT C -TREE MITIGATION WORKSHEET
❑ EXHIBIT D -TREE MITIGATION PLAN
SITE PREPARATION CHECKLIST
PLEASE PREPARE YOUR SITE AS FOLLOWS:
❑ Mark all trees identified for removal with RED or ORANGE flagging, paint or tape
❑ Mark all trees identified for preservation with BLUE or GREEN flagging, pain or tape
❑ Mark property corners with stakes or paint
❑ Barricade all trees 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
PROVISIONS OF CHAPTER 23 (PROTECTION OF TREES AND NATURAL VEGETATION) AND ALL OTHER APPLICABLE CODES AND
ORDINANCES OF THE CITY OF ATLANTIC BEACH.
.11' 4 /-�,
\ Q— ;�_- \A C er ajjq
SIGNATURE OF APPLICANT PRINT OR TYPE NAME DAT
02 TREE REMOVAL PERMITAPPLICATION 03.01.2018
EXHIBIT A: LETTER OF AUTHORIZATION
S City of Atlantic Beach
Community Development Department
800 Seminole Road Atlantic Beach, FL 32233
r (P) 904-247-5800
OWNER INFORMATION
NAME 1745 Beach Avenue LLC
ADDRESS 4667 Ortega Blvd.
CITY Jacksonville
AGENT INFORMATION
NAME
ADDRESS
CITY
STATE FL
STATE
FOR INTERNAL OFFICE USE ONLY
PERMIT #
PHONE # (904) 281-6204
CELL #
ZIP CODE 32210
PHONE#
CELL #
ZIP CODE
is hereby authorized to act on behalf of
the owner(s) 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 CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT: Signature of Property Owner(s) or Authorized Agent
a::E/ L `IiA (A'C� ' h-0 I h'
sitNARE-UF OWNER PRINT OR TYPE NAME DATE
SIGNATURE OF OWNER #2
PRINT OR TYPE NAME DATE
Signed and sworn before me on this day of Rpr, 2-019 by
Identification verified:
VQ, rsu)
Oath Sworn: J2/Yes
❑ ,oJANEE C WYATT
: • Notary Public • State of Florida
Commission # GG 312124
`'-;`'otic' My Comm. Expires Apr 21, 2023
Bondad tlitough National Notary Assn.
02 TREE REMOVAL - EXHIBITA: Letter ofAuthorization 03.01.2018
Notary Sign
State of Y( o r i dc
Countyof '(),L(V'' 1
My Commission expires `7' 7-1 Z 3
EXHIBIT B: TREE INVENTORY and PROTECTION PLAN
City of Atlantic Beach
Community Development Department
800 Seminole Road Atlantic Beach, FL 32233 FOR INTERNAL OFFICE USE ONLY
(P) 904-247-5800 PERMIT #
TREE INVENTORY -Please sketch an inventory in the area below or attach a site plan showing all existing trees on the property below
that are 3" diameter at breast height (dbh) and greater. Please complete the following:
• Note the location of all trees to be removed with an "X" • Note the location of all trees to be preserved with"[ ]"
• Number all trees and list on EXHIBIT C: Tree Worksheet • Show all existing and/or proposed buildings
TREE PROTECTION PLAN- (If you are doing construction on the site) -Please sketch and identify in the area below or on a copy of a
certified tree survey the location of the protective barricades to be installed prior to construction. Section 23-32(c) requires protective
barricades to be installed around every tree or group of trees to be preserved.
X
por h
(8)
tree
9
x
arric
es
AJ
11
V1
1
existing
drive ay
PREPARED BY: Drake Skinner SCALE:1 SQUARE= 10 FT
02 TREE REMOVAL - EXHIBIT 8: Tree Inventory and Protection Plan 03.01.2018
EXHIBIT C: TREE MITIGATION WORKSHEET
City of Atlantic Beach
Community Development Department
800 Seminole Road Atlantic Beach, FL 32233
(P) 904-247-5800
List the species and diameter at breast height (dbh) of all trees identified on EXHIBIT B
FOR INTERNAL OFFICE USE ONLY
PERMIT #
ID
DBH
SPECIES
removing
preserving
replOa =
COMMENTS (for use by City StafO
1
15"
Sabal palmetto
0
2
17"
Sabal palmetto
0
3
10"
Sabal palmetto
9
4
10"
Sabal palmetto
0
5
9"
Sabal palmetto
0
6
9"
Sabal palmetto
0
7
10"
Sabal palmetto
0
8
10"
Sabal palmetto
0
9
10"
Sabal palmetto
0
10
9"
Sabal palmetto
0
11
10"
Sabal palmetto
0
12
13
14
15
16
17
18
19
20
21
22
23
24
25
02 TREE REMOVAL -EXHIBIT C. Tree Mitigation Worksheet 03.01.2018