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325 9th Street TREE19-0049 10.04.2019 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 ADDRESS 3 C T " C T SUBDIVISION APPLICANT INFORMATION FOR INTERNAL OFFICE USE ONLY PERMIT# ❑ 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 RE# BLOCK # Z LOT # EMAIL P � 1-i.E�t,Ps �u� �t�1Cf� fJ P' STATE �(, ZIP CODE J / j PHONE # �, f — 4 `�'� 7��&L # (� �, 9� WNER ❑ LEGAL AUTHORIZED AGENT TREE REMOVAL PERMIT APPLICATION PACKAGE CHECKLIST PLEASE ATTACH THE FOLLOWING EXHIBITS: *Additional information maybe 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 1 HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IN THIS APPLICATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL PROVISIONS OF CHAPTER 23 (PROTECTION OF TREESAND NATURAL VEGETATION) AND ALL OTHER APPLICABLE CODES AND ORDINANCES OF THE CITY OF ATLANTIC BEACH. SIGNATURE OF APPLICANT 02 TREE REMOVAL PERMITAPPLICATION 03.01 2018 PRINT OR TYPE NAME DATE 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 rt� CCA 4E ," � C (^ ADDRESS �) C� $ 77 S f FOR INTERNAL OFFICE USE ONLY PERMIT # PHONE # CELL # CITY p4tef Iru F. c P C g� c� STATE r� r• ZIP CODE 3 Z Z AGENT INFORMATION NAME PHONE# ADDRESS CITY STATE 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 CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT: Signature of Property Owners) or Authorized Agent SI NATU E OF NER PRINT OR TYPE NAME SIGNATURE OF OWIy,E� #2 PRINT OR TY� NAME Signed and sworn before me on this ��. day of �P�CN� Identification verified: Oath Sworn: Yes ❑ No �L AU9REY M. LITTLES o�v P��G Notary Public, State of Florida _ " Commission# GG 259573 WoQ My comm. expires Sept. 17, 202'1 02 TREE REMOVAL -EXHIBIT A: Letter ofAuthorization 03,01.20 18 a r� t5 DATE TE by State of Y�U� Countyj T� UV03 ary Si�rfature Commission expires EXHIBIT B: TREE INVENTORY and PROTECTION PLAN City of Atlantic Beach Community Development Department 800 Seminole Road Atlantic Beach, FL 32233 (P) 904-247-5800 FOR INTERNAL OFFICE USE ONLY 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. PREPARED BY: 02 TREE REMOVAL - EXHIBIT B: Tree Inventory and Protection Plan 03.01.2018 SCALE: 1 SQUARE= )M Atr� \'(o f 4111*k �f 1 ,e t �� • )0,. , la - << PREPARED BY: 02 TREE REMOVAL - EXHIBIT B: Tree Inventory and Protection Plan 03.01.2018 SCALE: 1 SQUARE= EXHIBIT Co. 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 „ ,_ removing _ preserving 11 11 replOacing COMMENTS (for use by City Staff) 1 0) ppGM2 10 I®" 3 s 5 (� 6 1 l 7 8 ( G 9 10 11 12 13 1 ` 14 15 16 17 Q% 18 V Gl. 1C V 19 20 21 22 23 24 25 02 TREE REMOVAL -EXHIBIT C: Tree Mitigation Worksheet 03.01.2018