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380 Seminole Road TREE21-0008 02.25.2021 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 3RD Sfmi nol'*- SUBDIVISION S J�(,'(� (Z BLOCK # APPLICANT INFORMATION NAME ADDRESS 1 nSOh FOR INTERNAL OFFICE USE ONLY FILE # TRE7 " Ore ❑ Legacy Tree $ 25.00 ® Single -/Two -Family Residential $125.00 ❑ Multi -Family Residential $250.00 ❑ Commercial / Industrial $250.00 ❑ Institutional / Other Non -Residential $250.00 RE# (�Q yZS��OC70 )T# A00 EMAIL ooh i I�'e n � 9 @ y� �vv • cv�-i CITY ��f"(�� p3eQCG� STATE �L ZIP CODE 3 Z 233 PHONE# Lf �$'•y12-(t2,3'� CELL# WOS-�! IZ'r'�23� ❑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 ❑ 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. I AGREE TO COMPLY WITRf' PROVISIONS OF CHAPTER 23 (PROTECTION OFTREESAND NATURAL VEGETATION) AND ALL OTHER APPLICABLE CODES ORDINANCES OF THE CITY OF ATLANTIC BEACH. TORE OF APPLICANT 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 ' 1' ► ' be ` i m(l ADDRESS CITY wi I j (IM 111L r AGENT INFORMATION NAME ADDRESS CITY FOR INTERNAL OFFICE USE ONLY PERMIT # PHONE # L/(j5OfI2"02L57 CELL # STATE �L ZIP CODE 223 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. HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT: Signature of Property Owners) or Authorized Agent Z-I�=z1 DATE SIGNATURE OF OWNER #2 PRINT OR TYPE NAME DATE Signed and sworn before me on this � � day of �� �f �t�--ay �_ by A Identification verified; d , V Ca t Oath Sworn; ❑Yes 4 N Notary My Commission expires County of 0k V(I I 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 • Number all trees and list on EXHIBIT Co Tree Worksheet • Note the location of all trees to be preserved with LJ • 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: SCALE:1 SQUARE _ s EXHIBIT C; TREE MITIGATION WORKSHEET City of Atlantic Beach Community Development Department 800 Seminole Road Atlantic Beach, FL 32233 - ''It (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 I ] — preserving ��O replacing COMMENTS (for use by City Staff) 1 �-- 25 Palm X 2 �G •5 YV1 x 3 X 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 EXHIBIT D: TREE MITIGATION 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 # 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 _