1771 Maritime Oak Dr POD registration 1S1=LJ j',.
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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.
DATE 2 - ( A - 23
APPLICANT NAME: Ke .ii M c�
MAILING ADDRESS: I 0 Mari 410,...C., Ckl k-- '(y , 4-10 c-\L.6(2.G(..k-L-F
ADDRESS WHERE TEMPORARY STORAGE STRUCTURE WILL BE PLACED (If different from
mailing address)
SUBDIVISION Aro BLOCK# LOT#
DATES THAT THE
TEMPORARY STORAGE STRUCTURE WILL BE LOCATED ON THE
PROPERTY: 'CC\0 )t through t'\( Yar) 1-
X Residential
-
XResidential property
❑ Commercial (Provide survey or site plan showing location where structure will be placed.)
❑ Other
I HEREBY CERT THAT ALL INFORMATION PROVIDED IS CORRECT.
Signature of prope owner or authorized agent.
SIGNATURE PRINT NAMELlM) V l C.,-InCA(-
7
CONTACT INFORMATI I OF PERSON SUBMITTING THIS REGISTRATION FORMLEASE PRINT)
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NAME Lo)S \ (T rwirn
MAILING ADDRESS I-1-1 O TA UY-► I 1-,\(_, b U pr.-. i\-(\00-1- 1c_. &G VIS COQ 3233
PHONES 1'1(`k Z'P Z O FAX E-MAIL 01 S vALQ b el I$04j'1 ,rvzst
Revised May 2012 •