365 10 ST - TREE20-0036 .;�,-,i. TREE REMOVAL PERMIT APPLICATION
t :t_* '.;:, City of Atlantic Beach
X Community Development Department
•.: Community FOR INTERNAL OFFICE USE ONLY
800 Seminole Road Atlantic Beach,FL 32233
`''i',,;,):)%. Y (P) 904-247-5800 PERMIT# I Ree ZO—Oo3(c
INSTRUCTIONS ❑ Legacy Tree $ 25.00
1. Complete and sign this application. 0 Single-/Two-Family Residential $125.00
2. Attach required exhibits as listed on application checklist.
❑ Multi-Family Residential $250.00
3. Contact the Community Development Department if you have questions.
4. Submit the completed application and all required exhibits,along with E Commercial/Industrial $250.00
application fees to the Permits Desk at Atlantic Beach City Hall. ❑ Institutional/Other Non-Residential $250.00
SITE INFORMATION/ {'7
ADDRESS 365 GI) A „ch-c,_4.- /fIIwi1v 6c i' R._ RE# 1 700gs-- cx—iz:,
SUBDIVISION PI„l X1701 / SN_b "A" A(.,, .ht, 6s,41 BLOCK# t LOT# 30
APPLICANT INFORMATION "
NAME Aj.,,,, (j(� EMAIL Ad��tf ,vcrCiJ�•i,(In�i
ADDRESS L 5 ?A21 �Avc 5�,� CITY j genal` STATE f(.„, ZIP CODE 32,ZAj
PHONE# 411., 5v)-),,93(f CELL# °IN- SD2.-,IJL[ E 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
[Z] EXHIBIT A(Option 1)-PROOF OF OWNERSHIP:Copy of Warranty Deed that verifies record of owner(Clerk of Courts)
VEXHIBIT A(Option 2)-LETTER OF AUTHORIZATION: Please complete if the applicant is not the owner
[Z EXHIBIT B-TREE INVENTORY and TREE PROTECTION PLAN
,/ EXHIBIT C-TREE MITIGATION WORKSHEET
mr 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
El 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.
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NATURE OF APPLICANT PRINT OR TYPE NAME ( D E
02 TREE REMOVAL PERMIT APPLICATION 03.01.2018