Permit POD 510 Selva Lakes Cir 2011 MAY-9-2011 06:35 FROM: TO:2475845 _ P.1/1
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City of Atlantic Beach 800 Sc r0ole Road Atlantic Bench,Florida 32233-5445
http'.//www/ci.otl nntle-beach.fl.us
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REGIS TION FORM
FOR TEMPORA : STORAGE STRUCTURES
Portable storage structures may be used with a City of Atlantic Beach following submittal of this completed
form to the Building and Zoning Department, V ithin all residential Zoning Districts, these may be used only for
the temporary storage of personal household . 1 ngings of occupants of the property and may be placed on the
property for a period not taliNl�, tl!i 96) hours. Registration is required each time that a
temporary storage structure is placed on the pro a In the event of damage to a residence by fire, storm, flood, or
other such property loss, this period of:time ma a extended to ten (it)).days upon_requcst to grtd--written approval
of the Ciry Manager. Within all non-residentia ping Districts, enclosed portable storage structures may be used
for temporary storage of items related to the bu i ss located on the property, for a period not to exceed thirty (30)
days. Such structures cannot be located withi ont yard setbacks and shall not be used to store any chemical,
hazardous, flammable or combustible materials,
DATE
APPLICANT NAME. 77f-c(z�
MAILING ADDRESS:
ADDRESS WHERE TEMPORARY STO STRUCTURE WILL BE PLACED (1(f different from
1ndlling address,) S / -s/ [/ ['„� 2-Z
SUBDIVISION BLOCK # LOT#
DATES THAT THE TEMPORARY STORA'. STRUCTT.TRE WXLL BE LOCATED ON TEM `
PROPERTY: — through — In
Residential property
❑ Commercial (Provide survey or Ate plan b wing location where structure will be placed.) t�
❑ Other
I HIREBY CERTIFY THAT ALL INFO ON PROVWED IS CORRECT.
Signature of property owner or authorized age
SIGNATURE PRINT NAME
CONTACT INFORMATION OF PERSON StQJ TTING THIS REGISTRATION FORM (PLEASE PRINT)
N AM
MAILING ADDRESS LAW
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