379 10th Street TREE20-0006 02.24.2020 SCTREE REMOVAL PERMIT APPLICATION
City of Atlantic Beach
Community Development Department
800 Seminole Road Atlantic Beach, FL 32233
(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 L
ADDRESS 3 %
SUBDIVISION 3l(� j �� �an Ti'C� BLOCK # / 3
APPLICANT INFORMATION
NAME
FOR INTERNAL OFFICE USE ONLY
PERMIT # �T��E dZy'DOt
❑ Legacy Tree $ 25.00
❑ Single- /Two -Family Residential $125.00
❑ Multi -Family Residential $250.00
❑ Commercial / Industrial $250.00
❑ Institutional / Other Non -Residential $250.00
LOT # 39
EMAIL _ 17h��"IZ�I{iir �,G,1 /�'%� (C�/-✓I
STATE � ZIP
CODE 3��C
PHONE # CELL # aCX) - lQp�(J KOWNER ❑ 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
PROVIS SOF CHA R (PROTECTION OF TREES AND NATURAL VEGETATION) AND ALL OTHER APPLICABLE CODES AND
ORDIN ES ITY F ATLANTIC BEACH.
SIGNA O A PLI T PRINT OR TYPE NAME ATE
02 TREE REMOVAL PERMITAPPLICATIONO3.01.2018
EXHIBIT A: LETTER OF AUTHORIZATION
City of Atlantic Beach
Community Development Department
800 Seminole Road Atlantic Beach, FL 32233
(P) 904-247-5800
FOR INTERNAL OFFICE USE ONLY
PERMIT #
OWNER INFORMATION
NAME �(� (��-I�� PHONE#
ADDRESS
CITY J tl
AGENT INFORMATION
NAME
ADDRESS
CITY
CELL # a
STATE ZIP CODE
STATE
PHONE #
CELL #
ZIP CODE
is hereby authorized to act on behalf of
the owners) 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 CgRTIFY THAT AI�INFORMATION PROVIDED IS CORRECT: Signature of Property Owners) or Authorized Agent
SIGNATI'FRE OF OWNER
SIGNATURE OF OWNER #2
Signed and sworn before me on this � � day of
f: he� t �
Identification verified:
PRINT OR TYPE NAME
PRINT OR TYPE NAME
by
DA E
DATE
County of U
7
Oath Sworn: � Yes
DAWN LEMIRE ignature
IW O MIMSSION # GG3189w
EXPIRES: April 2, 2023 M Commission expires
c�
Bonded thru CAN Surer Y p
02 TREE REMOVAL - EXHIBITA: Letter of Authorization 03.0 7.2018
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
11 11
X
removing
11
preserving
O 11,
replacing
COMMENTS (for use by City Staff]
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02 TREE REMOVAL - EXHIBIT C: Tree Mitigation Worksheet 03.01.2018
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