202 Pine Street TREE19-0035 CANCELLEDTREE REMOVAL PERMIT APPLICATION
City of Atlantic Beach
Community Development Department
800 Seminole Road Atlantic Beach, FL 32233
(m19' (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
FOR INTERNAL OFFICE USE ONLY
PERMIT # I REf-:-- t c l" UCS.
jWLegacyTree — 5\0e '_7V_ G -UM $ 25.00
® Ingle, Two -Family Residential $125.00
❑ Multi -Family Residential $250.00
❑ Commercial / Industrial $250.00
❑ Institutional /Other Non -Residential $250.00
ADDRESS RE# k_7 d 5521 — 00ff>
SUBDIVISION SP,,L.:-V BLOCK # LOT # SZ�
APPLICANT INFORMATION
_ 11 �c�c_.�.►e P� �Saa�- I �
NAME EMAIL
ADDRESS 2 0� �e-�,�e�— CITY .A� STATE Fl_ ZIP CODE
PHONE # CELL # b4_1470 - 0,5 Z, 7 j j 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
f 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.
-�Uc�� t Y1 nl I O�-7 ?2J zo l Cl
I N RE OF APPLICANT PRINT OR TYPE NAME DATE
02 TREE REMOVAL PERMITAPPLICATIONO3.01.2018
EXHIBIT B: TREE INVENTORY and PROTECTION PLAN
City of Atlantic Beach
Community Development Department
J v 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)Rnr± --+-r.
• Note the „i�, ; ,,; cta s.. c (f70 f Ig 011 trt
�l• Number :,trees and list sn EXNiP,T ose T
TREE PROTECTIO; PLAN- (ffyou are doing con on ase �� (S N ify, i th are jr on a copy of a
0
certified tree surve r the (station of the protective ;trs
to ns�a►i,_;� nserucri! e n squires protective
barricades to be in �.alled around every tree or gro to a preserv� 00 L
I
r�
PREPARED BY: lK� 11 r\te O :'SCALE: i SQUARE
02 TREE REMOVAL -EXHIBIT B. Tree Inventory and Protection Plan 03.01.2018
1
,-5���,�,;EXHIBIT C: TREE MITIGATION WORKSHEET
�S City of Atlantic Beach
s 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
replacing
COMMENTS (for use by City Staff]
1
Z4 V
Sw�GxQ
2
3
0
5
6
��r
7
�O J'i
s
-4A
►A8c\e(A 1 r A
9
/y� .
eetk
10
11
2
13
14
15
16
17
18
19
20
21
22
23
24
25
02 TREE REMOVAL - EXHIBIT C Tree Mitigation Worksheet 03.01.2018