1717 Selva Marina POD Registration rS�1�y l
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City of Atlantic Beach • 800 Seminole Road •Atlantic Beach,Florida 32233-5445
Phone: (904)247-5855 • FAX (904)247-5845 www.coab.us
REGISTRATION FORM
FOR TEMPORARY STORAGE STRUCTURES
Portable storage structures may be used within the City of Atlantic Beach following submittal of this completed
form to the Building and Zoning Department. Within all residential Zoning Districts, these may be used only for
the temporary storage of personal household belongings of occupants of the property and may be placed on the
property for a period not to exceed four(4) days or ninety-six(96)hours. Registration is required each time that a
temporary storage structure is placed on the property. Within all non-residential Zoning Districts, enclosed portable
storage structures may be used for temporary storage of items related to the business located on the property, for a
period not to exceed thirty(30)days. Such structures cannot be located within front yard setbacks and shall not be
used to store any chemical,hazardous,flammable or combustible materials. t 0/ /
DATE /AU6- ->Z-9--kt
1
APPLICANT NAME: `c\k_c CT-re-,2X1
MAILING ADDRESS: I t -7 < Q \ vi* Inv\Q• yu
ADDRESS WHERE TEMPORARY STORAGE STRUCTURE WILL BE PLACED (If different from
mailing address)
SUBDIVISION BLOCK# LOT#
DATES THAT THE TEMPORARY STORAGE STRUCTURE WILL BE LOCATED ON THE
lcr � \ \ ,
PROPERTY: t through 7
OResidential property
0 Commercial (Provide survey or site plan showing location where structure will be placed.)
❑ Other
I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT.
Signature of property owner or authorized agent.
SIGNATURE /A:_�' PRINT NAME
<0c
CONTACT INFORMATION OF PERSON SUBMITTING THIS REGISTRATION FORM (PLEASE PRINT)
NAME 114
MAILING ADDRESS \ 1' -e lv ) \J\o _A r _
PHONE ti t5'(9-7) - 2>5 to I FAX E-MAIL CLudtrei 1r c -tom
U I \ ve .
Revised May 2012