Permit POD 499 Selva Lakes Cir 2011 TO:2475845 P.1'1
nW-11-2010 08:24 FROM: --••
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City or Atlantic Beach 800 Seminole Road •Atlantic Beach,Florld• 32233-5443
• Phone: (904)247-3800 FAX (904)247-OAtI"! • htip t//www/cl.etlantIc-baach.fl.us
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REGISTRATION FORM
FOR TEMPORARY STORAGE STRUCTURES
Portable storage-structures may be used within the City of Atlantic Beach following 'sub r'ittal of this completed
form to the wilding end Zoning Department. Within all residential Zoning Districts, these may be used only lo!
the temporary storage of personal household belongings of occupants of the property and;may be placed on ih.-
property for a period not to exceed four (4) days or ninety-six (96) hours. Registration is rtjquired arch time that s
temporary storage snvctWt is ple4ed on the property. In the event of damage to a residence by fire,storm, flood, or
other such progerry loss, this period of time may be extended to ten (l0}days upon-request to and-written approva!
of the City Manager. Within all non-residential Zoning Districts, enclosed portable storage tstructures 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 stdre any chernica"s
hatardous, flammable or combustible materials.
DA'V'E
APPLICANT NAME: . !og- ��ei Qter-6— n
MAILING ADDRESS:
ADDIUSS WEEIt'y' MPORARY STORAGE STRUCTURE WMI;BE PLACED (If different from
SUBDIVISION �`—/O, _ , BLOCK NL OTIi
DATES THAT THX TE OR,ARY STORAGE STRUCTURE WILLIE L0 ATED ON THE
PROPERTY: �tbrougb
,.�'Residendsl property D-
❑ Commercial (Provide survey or site plan showing location wbere structure will be placed.)
[I Other
JOAS 103 8114101S V#qj'%0W 1=8 04,L
f HEREBY CERTIFY THAT ALL SN�
Signature of property owner or authortze agej
SIGNATURE PRINT NAME
CONTACT INFORMATION OF PERSON SUBMITTINGTMS REGISTRATION FORM (PLtiAst rltt-'T)
NAME
MAILING e.DDRY.SS
PHONE FAX X-MAM