1590 Beach Avenue TREE19-0039 EXPIREDTREE 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 VF
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 1590 Beach Ave, Atlantic Beach, FL 32233
SUBDIVISION
APPLICANT INFORMATION
NAME Summer Reian Inc
ADDRESS 2107 Hendricks Ave, Suite 202
PHONE # 904-399-8616
CELL # 904-307-9374
FOR INTERNAL OFFICE USE ONLY
PERMIT #
❑ Legacy Tree $ 25.00
❑X Single- /Two -Family Residential $125.00
❑ Multi -Family Residential $250.00
❑ Commercial / Industrial $250.00
❑ Institutional / Other Non -Residential $250.00
RE# 1718760000
BLOCK # Mandalay LOT #
CITY Jacksonville
EMAIL leonln32@gmail.com
11
STATE FL ZIP CODE 32207
❑ OWNER ❑X 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
PROVISIONS OF CHAPTER 23 (PROTECTION OFTREES AND NATURAL VEGETATION) AND ALL OTHER APPLICABLE CODES AND
ORDINANC�B')DF THE CITY OF ATLANTIC BEACH.
SIGNATURE OF APPLICANT
02 TREE REMOVAL PERMITAPPLICATIONO3.01.2018
Lisa Pugh
PRINT OR TYPE NAME
08/08/2019
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 Summer Reign Inc
ADDRESS 2107 Hendricks Ave, Suite 202
CITY Jacksonville
AGENT INFORMATION
NAME Lisa Pugh
ADDRESS Same as above
CITY
Lisa
Summer Reign Inc
FOR INTERNAL OFFICE USE ONLY
PERMIT #
PHONE # 904-399-8616
CELL # 904-307-9374
STATE FL ZIP CODE 32207
STATE
I�:I:�7►1�'i
C�
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
W
SIGNATURE OF 0�1/NER
Lee Nutter
PRINT OR TYPE NAME
TURE OF OWNER #2 PRINT OR TYPE NAME
Signed and sworn before me on this � day of �� � � - O �by
L CJ a 1+"(? ,/�
Identification verified
Oath Sworn: tLj
Yes
Notery Public Stats of Florida
Neewa J Phelps
My Commission GG 232771
Expires 10/21/2022
Letter ofAuthorization 03.01.2018
08/08/2019
DATE
County of �U U�t, �'
Notary Signature
My Commission expires
02 TREE REMOVAL - EXHIBITA:
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
02 TREE REMOVAL -EXHIBIT
DBH
SPECIES
removing
preserving
replOacing
COMMENTS (for use by City Staffl
1
9.5"
Palm Tree
2
13
Palm Tree
]
3
12"
Palm Tree
4
11"
Palm Tree
X
5
13
Palm Tree
6
11"
Palm Tree
/ w
7
10
Palm Tree
8
11
Palm Tree
{
9
14"
Palm Tree
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Int9ccf, t offf G
25
C: Tree Mitigation Worksheet 03.01.2018
46' - 3 19/32"
property line
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NOTES
T. BEARINGS ARE BASED ON THE _ASWMED. BEARING OF _S 03'54'51_E ALONG THE
WESTERLY RIGHT OF WAY UNE OF BEACH AVENUE,
2 NBY ATIONAL (C PLOTTING FLOOD INSURANCE AP LY THE CAPTIONED
JUNLANDS.2013, COMMU NUMBER 120075. PANELS oar 9H ON THE
3. THIS SURVEY REFLECTS ALL EASEMENTS & RIGHTS OF WAY AS PER RECORDED PLAT &/OR TITLE COMMITMENT
IF SUPPLIED. UNLESS OTHERWISE STATED. NO OTHER TITLE VERIFICATION HAS BEEN PERFORMED BY THE UNDERSIGNED
4: THIS SURVEY 15 NOT VALID WITHOUT AN AUTHENTICATED ELECTRONIC SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL
JOB g 3235 1 DATE OF FIELD SURVEY: 3-23-2017
Ray Thompson CERTIFICATE
I HEREBY CERTIFY THAT IH15
SURVEYING, Inc.
AND MEETS TME sTANDAL
ROARD OF PROFESSION L 5 A
Going the DIS0000
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1825 University Boulevard West
Jacksonville, Florida 32217 v RAYMOND TH
(Phone) 904448 5125 REGISTERED SUR OR Atlfl tMAP
(Fax) 904-44B-5178 SEFBUSINE
REVISIONS
'ON5IBLE CHARDS
: FLIXtIDA
51-n, FLORIDA
STANTES.
STATE OF FLORIDA