Permit POD 667 Selva Lakes Cir 2010 OCT-12-2010 06:58 FROM: TO:2475845 P.1/1
�!P J ez3,3
City of All 0ntic Beach 800 Seminole Road Atlantic Beech, F1Qr 2233.344
Phonc: (904) 247.5800 FAX (904)24744 ' http://www/ci,20antic och.11.us
REGISTRATION FORM
FOR TEMPORARY STORAGE S'z'RUCTTJRJ�S
'Portable slorase-srructwes may be used within the City of Atlantic Beach following 'submittal of this completec
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 in,-property for a period not to exceed four (4) days or ninety-aix (96) hours, Registration is required each time that s
temporary storage srructure is placed on the property, In the event of damage to a residence by fire,storm, flood, or
other such prajf rt loss, thin period of time may be extended to ten (10) days upon-request to turd written approve!
of the City Manager. Within ell non-residential Zoning Districts, eriolosed portable storage sto•uctures 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 chemics!
hnznrdo.us, flammable or combustible materials.
DATE �T
APPLICANT NAME!
MAILING ADDRESS:
ADDRESS wIM1tE T M?
O Y STORAG4 ST UCT 'mj��WILL BE PLACED (If different from
rni,Uing address.) ¢,. a d1
SUDDIYISION BLOCK N--- ..LOT# ..
DATES THAT THE TEMPORARY STORAGE STRUCTUIM WILL BE LOCATED ON THE
PRUP1rRTY; &—=i 2 ��_
OE�''Rcsideotlal property
❑ Commercial (Provide survey or site plan snowing location wbere structure will be pinced.)
Q Other
I aREBY CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT.
Sig ooturc of property owner O r a u.tborLzed agent.
SIGNATURE p `
The 9eit MOVIES&Storme Idea Ever
CONTACT INFORMATION OF PERSON SUBMITTING THIS RE ,r ORM (Pt,rtist:Ptu��
NAME
NIA.ILINC ADDitESS
PHONE FAX E-M API;