Permit POD 1017 Jasmine 2011 OCT-1-2011 12:59 FROM: TO:2475845 P.1/1
3 z 3
4
City of Atlantic Beach $00 Seminole Road -Atlantic Beach,Florida 32233-5445
http t//www/ci.atiantic-boach.fl-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 (96) hours. Registration is required each time that a
temporary storage structure is placed on the property. In the event of damage to a residence by fire, storm, flood, or
other such property loss, this period of time may be extended to ten (10).days upon request to 9,nd-written approval
of the City Managcr. 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
APPLICANT NAME: U ��_St,JAV%.,��/�,_
MA-1-LING ADDRESS: !QM Q A rr a-P 7"
ADDRESS V4HER1K..TEMPORARY STORAGE STRUCTVU WILL BE PLACED .(If different from
tnailing address.)
SUBDIVISION BLOCK# LOT#
DATES TZlAT THE T.EMPORARI STORAGE STRUCTLW WILL BE LO ATED ON TEE
PROPERTY: Z17 through
Residential property
❑ Commercial (Provide survey or site plan showing location where structure1
❑ Other
8498 Mallory Road
I id=EREBY CERTIFY THAT ALL INFORh�ATION pR0'VXDED IS �fi?���TI`tN�IIFla �L S��O
Signature of property owner or ituthorized agent.
SIGNAT'URS - � ,� PRINT NAME AleicAr
CONTACT INFORMATION OF PERSON SUBMITTING THIS RE91ST ION FORM (PLEASt PR24'n
N AM
MAILING ADDRESS KW? _j
PHONE PAX E-MAIL