427 Inland Way TREE19-0046 ApplicationTREE REMOVAL PERMIT APPLICATION
' \ City of Atlantic Beach
! Community Development Department
800 Seminole Road Atlantic Beach, FL 32233
'WIN", (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 421 141
FOR INTERNAL OFFICE USE ONLY
PERMIT#
❑ Le acy Tree $ 25.00
Single- / Two -Family Residential $125.00
❑ Multi -Family Residential $250.00
❑
Commercial/ Industrial $250.00
❑ Institutional/ Other Non -Residential $250.00
whC32?,3
RE# 1 6 14 (D 2) — l S Z(o
SUBDIVISION'
C)CC�QnI.JaJK 4— BLOCK# 012 ro 3S%—Z(IULOT#
13
APPLICANT INFORMATIOONi N j
NAME ��l(VLI ti1� 1 1 I V"V' EMAIL 5' jt i4l f' -Li �'1 (I W1.do& PoSVl - ew
ADDRESS I17 t iILG( tj W(C�� CITY W&I.f I` At51 STATE Iti ZIP CODE 37.233
PHONE#
CELL # qVq -"--S' C)j 4OWNER ❑ 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
ORDINANC SOFT E C Y OF ATLANTIC BEACH.
IGNATURE O APPLICANT PRINT OR TYPE NAME I DTE
02 TREE REMOVAL PERMITAPPLICATIONO3.01.2018
:.�J EXHIBIT A: LETTER OF AUTHORIZATION
City of Atlantic Beach
Community Development Department
800 Seminole Road Atlantic Beach, FL 32233
(P) 904-247-5800
OWNER INFORMATION
NAME ( ( I tk
ADDRESS %/� nW 4 VV
CITY I':' �;a;j
AGENT INFORMATION
NAME
ADDRESS
CITY
STATE I'l�
1►01r_1r4
FOR INTERNAL OFFICE USE ONLY
PERMIT #I-
PHONE #
CELL#
ZIP CODE 3
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
SIGNATURE OF OWNER #2
PRINT OR TYPE NAME DAT
PRINT OR TYPE NAME
Signed and sworn before me on this day of v ( by
Identification verified:
Oath Sworn: ❑ Yes Nti'
,,, TONI GINDLESPERGER
MY COMMISSION # FF 924951
EXPIRES: October 6. 2019
f ° ' Bonded Thor Notary Publ'w Undere tern
02 TREE REMOVAL - EXHIBITA: Letter ofAuthorization 03.01.2018
Notary Signature
My Commission expires
DATE
State of t�
County of w�% �—
j�5,N Z — EXHIBIT B: TREE INVENTORY and PROTECTION PLAN
City of Atlantic Beach
s Community Development Department
+� yr 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.
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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
0 800 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
X
removing
[ ]
preserving
O
replacing
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1 02 TREE REMOVAL - EXHIBIT C. Tree Mitigation Worksheet 03.01.2018 1
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THATTHIS SURVEY MEETS THE MINIMUM TECHNICAL
STANDARDS AS SET FORTH BY THE FLORIDA BOARD
OF LAND SURVEYORS, PURSUANT TO SECTION 472.027
FLORIDA STATUTES AND CHAPTER 21 HH -6 FLORIDA
ADMINISTRATION CODE.
H. A. DURDEN
& ASSOCIATES,...
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SCALE:
THIS SURVEY NOT VALID UNLESS THIS PRINT IS EMBOSSED WITH THE SEAL OF THE ABOVE SIGNED.
FILE NO. �Q ?)
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