315 12th Street TREE20-0033 Application VOID_~i'~' TREE REMOVAL PERMIT APPLICATION
"~ City of Atlantic Beach , 11\ ;( ~~ Community Development Department FOR INTERNAL OFFICE USE ONLY C)~ .,; 800 Seminole Road Atlantic Beach, FL 32233
/· ... !JH v}-(P) 904-247-5800 FILE#
INSTRUCTIONS D Legacy Tree $ 25.00
1. Complete and sign this application. D Sing le-! Two-Family Residential $125.00
2. Attach required exhibits as listed on application checklist. D Multi-Family Residential $250.00 3. Contact the Community Development Department If you have questions.
4. Submit the completed application and ali required exhibits, along with D Commercial! Industrial $250.00
application fees to the Permits Desk at Atlantic Beach City Hall. D Institutional! Other Non ·Residentlal $250.00
SITE INFORMATION
ADDRESS ]\~ IZ~ S±red" A t\-~-j,ii.-lW~~ I pI, 3~,$~ RE#
SUBDIVISION BLOCK # LOT#
APPLICANT INFORMATION
NAME 'te .\\owsh,,,(... \AlIcI\~tV ~ .. ~,\I.-\(.J.i ~ EMAIL K I'-vb; I<-e 'fl lhlls},y.~/4.A5 ¥. (oA
ADDRESS U~;, ~\)bet+ S'l-rftA"--CITY J4c..bo Qv;llt. STATE r:L ZIP CODE suo1-
PHONE# CELL# £JO~-4(p 1-I1HS' DOWNER ~GAL AUTHORIZED AGENT
TREE REMOVAL PERMIT APPLICATION PACKAGE CHECKLIST
PLEASE ATTACH THE FOLLOWING EXHIBITS:
*Addltional Information may be required, depending upon circumstances unique to individua l applications
~XHIBIT 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 comp lete If the applicant Is not the owner
D EXHIBIT B .. TREE INVENTORY and TREE PROTECTION PLAN
D EXHIBIT C .. TREE MITIGATION WORKSHEET
D EXHIBIT 0 .. TREE MITIGATION PLAN
SITE PREPARATION CHECKLIST ri' PLEASE PREPARE YOUR SITE AS FOLLOWS:
Mark ali trees Identified for removal with RED or ORANGE flagging, paint or tape
D Mark all trees Identified for preservation with BLUE or GREEN flagging, pain or tape
D Mark property corners with stake s or paint
D 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 T ~ ATLANTIC BEACH.
j<~k f.. V h; I<-6/&./ lOll) SIGNATUREO~~ PRINT 0 TYPE NAME DATE
02 TREE REMOVAL PERMIT APPLICATION 03.01 .2018
TREE20-0033
fI:lfa EXHIBIT A, LETTER OF AUTHORIZATION
IJ\ ~~ City of Atlantic Beach
ii:: Community Deve lopm ent Department
FOR INTERNAL OFFICE USE ONLY , • '-./ ',", 800 Seminole Road Atlantic Beach, FL 32233
~l. (P) 904 -247 -5800 PERMIT #
OWNER INFORMATION
NAME ~JI~ Maf('o-\-.f--e...... PHONE # CJD'I-778'-&/ (, (
I
I J-fh CELL # 90Lj-7 /::f -G, I u I ADDRES S 31:;-si-
CITY (\ -I-\ a.,,~c !Qeoch STATE (L ZIP CODE 3;;1;)3'3
AGENT INFORMATION
NAME ~ tIl OIl5-hJAe-L~"u4 Ci fe..-~l\" ~,,~ I\:-PHONE # 101 '6' 'f-1Qs-
ADDRESS ,/~ ~ iW),trt-Stred-CELL# 7fII ·6~1--2'~~;-
CITY lC1t~~"I\k-STATE rL ZIP CODE suo1-
~~\lO~\to~ L..",!5.£ ~~e, Is hereby authorized to act on behalf of
!<"l /e I
M Q,<o-l+-e-the owner(s) of those lands described
in the attached application and as describ ed 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
~~r-k J<~Ie. Mo..V"LOH<-8 / t., L ~OdO
DAl E ' SIGNl"URE OFONER PRI T OR TYPE NAME
SIGNA _
ICjf k j(u~1 ~
PR INT 0 TYPE NAME W-'LtoZD DA E
Signed and sworn befor e me on this ~ day of Au3 kk , 2.02-0 by State of non'dec
7)/Av'o.J County of
Identifi cation verified : IX y,> t> VI aU q known
J J ?£.;CCUUL Oath Sworn : Cive s ONo IJ!}v= ,,,,,,~,, KEllY L U ,.i'ifil 'I\\t;-, ICA SI Notary Signature
[.fA"'] MY COMMISSION # GG 910329 S-epf:ember 1, :Jn~3 '-~' W EXPIRES: Septembel4, 2023 My Commis sion ex pire s -'~~r.il<?'" Bonded ThN NoCaoy I'IIbJJc UndeIwI1IeR
02 TR EE REMOVAL -EXHIBI :Leece, 'v"v,,<v'o
rfIij EXHIBIT B, TREE INVENTORY .nd PROTECTION PLAN
;'q) City of Atlantic Beach
. \~\ Community Development Department
:" /-"-800 Seminole Road Atlantic Beach, FL 32233 FOR INTERNAL OFFICE US E ONLY
~ (P) 904-247-5800 PERMIT #
TREE INVENTORY-Please sketch an inventory In the area below or attach a site plan showing all ex isting trees on the property below
that are 3" diameter at breast height (dbh) and greater. Please complete the following:
• Note the lo cation 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 prop osed buildings
TREE PROTECTION PLAN-(If you Qre doing construction on the slte)-Please ske tch and Identify In th e area below or on a copy of a
certified tree survey the loca tion 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.
PREPARED BY: SC ALE: 1 SQUARE;
02 TREE REMOVAL -EXHIBIT B: Tr ee Inventory and Protection Plan 03.01.2018
F ~ EXHIBiT C, TREE MITIGATION WORKSHEET
'-w~ City of Atlantic Beach
-ll\ '.1 Community Development Department
/'" 800 Seminole Road Atlantic Beach, FL 32233 FOR INTERNAL OFFICE USE ONLY
(P) 904-247-5800 PERMIT #
List the species and diameter at breast height (dbh) of all trees identified on EXHIBIT B
ID DBH SPECIES
IIX": "[ )"~ "0 "= COMMENTS (for use by City Staff) removing preserving replacing
1
2
3
4
5
6
7
8
9
10
11
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
,-SW.\l'j -,r EXHIBIT 0: TREE MITIGATION PLAN "~ City of Atlantic Beach S,~ I~ r' n Community Development Department u'I.. ~ 800 Seminole Road Atlantic Beach, FL 32233 FOR INTERNAL OFFICE USE ONLY
/-:t.U;{ !>}-(P) 904-247-5800 PERMIT #
Please identify the location, species and size (caliper inches) of ALL trees to be planted for mitigation credit in the area below or on a
separate site plan, Please include existing and/or proposed buildings and any street names for reference points.
PREPARED BY: SCALE: 1 SQUARE =
02 TREE REMOVAL -EXHIBIT D: Tree MitigatIon Plan 03.01 .2018
~ EXHIBIT B, TREE INVENTORY ,"d PROTECTION PLAN
~ City of Atlantic Beach ~ Community Development Department 5 A foil 'P LE
./ 800 Se minol e Road Atlantic Beach , FL 32233 FOR INTERNAL OFFICE USE ONLY
(P) 904-247-5800 PERMIT #
TREE INVENTORY-Plea se sketch an inventory in the area b elow or attach a site plan showing all exi sting trees on the property below
that are 3" diameter at breast height (dbh) and greater. Pl ease complete the following:
• Note the lo cation of all trees to be remov ed with an "X" • Note the location of all tree s to be preserved with "( r
• Number all trees and list on EXHIBIT C: Tree Work sh eet • Show all existing and/or proposed build ings
TREE PROTECTION PLAN-(/fyou are doing comtrucrlon on the .'te)-Please sketch and identify in the area b elow or on a copy of a
certified tree surv ey the l ocation of the protective barricades to b e install ed prior to construction. Section 23 -32(c) requires protective
barrica d es to be installed around every tree or group of tr ee s to be pr es erved .
1'(-loP, 1St: 0
I ~ ::(2
VIl U::. (-4 ) . Of( j((i NO 1'00 ""J., \ (<0 kt? . c:. 10 ",
v ,. -t'--
., 1/ 1M ~~ II-Lo. W£:
.1 " I\.
( '? ) 17 1/\ .L ./ 1\ ,/' " i-
171 r (
..,/ I"" Xt I \... ~ V ~ /
r:::X' 5T l.N t:? I. (Ju. S£:.
1e ,
8 '" , .J
N ~~ 1'~ r=E~
t1k ~ .' (
q ~I ) )'
Ii 12-" ~, '" ~ ---rr:; / \ Y
'fiZ. IE.E
&l ce.M fN( )Lf 'PI , )a.f )
rp i uU< J"c.c WE:
PREPARED BY : SCALE: 1 SQUARE =
02 TREE REMOVAL · EXHIBIT 11: Tree Inventory and Prote ction Plan 03 ,0 1.20' 8
~ EXHIBIT Co TREE MITIGATION WORKSHEET
.-.. -\ City of Atlantic Beach
~ Comm unity Deve lopment Department SAMf'L£.
/ 800 Sem inol e Road Atlantic Beac h, FL 32233 fOR INTERNAL OFFICE USE ONLY
. (P) 904-247-5800 PERMIT #
Lis t the spec ies and diameter at breast height (dbh) of all trees identified on EX HIBIT B
ID DBH SPECIES "X"= "(]"~ "0"= COM MENTS (for use by Ci ty Sta m removing pre se rving rep lac in g
1 10" Palm •
2 10" Pa lm •
3 10" Pa l m •
4 20" Syca more •
5 13 " Elm •
6 24" Liv e Oak •
7 6 " Holly •
8 14 " Pine •
9 11 " Palm •
10 17" Pine •
11 10" Pa lm •
12 S" Oak •
13
14
15
16
17
18
19
20
2 1
22
23
24
25
01 TREE REMOVA L· EXHIBITC: rre eMitigotioll WOlksh ee t 03.01 .2018