Permit POD 273 Pine St 2012 JAN-7-2011 09:50 FROM: TO:2475845 P.1
�P 3 ZZ3 JAN 07 2011
City of Atlontle Bench Aoo Seminols Road Atlantic Batch, Florida 31233-5445
p►tnne: (904) 247.5800 FAX (904)14'1 '! - http://www/cl.otiontic-beach.n.us
2 y7' �ay�
REGISTRATION FORM
FOR TEMPORARY STORAGE STRUCTURES ,t
Portable storage.savcttrres may be used within the City of Atlantic Boaoh 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 Inc
properry for a period not to exceed four (4) days or ninety-six(96)hours, Regi8tration is required'each time that _
temporary storage structure is placed on the property, In the event of damage to a residence by fire,storm, flood, or
other such property 1033, this period of time may be extended to ten (10) days upon,request to knd"writteq approve-i
of the City Manager. Within all non-residential Zoning Districts, enclosed portable storage structures may be ust o
for temporary storage of items related to the business located on the property, for a period not to,exceed thirry (
drays Such structures cannot be located within front yard setbacks and shall not be used to store any chemical
ha%ardqus, nammable or combustible materials. PATE n� 20 ��y
APPLICANT NAME: S hC.G
MAILING ADDRESS:
ADDRESS WHERE TEMPORARY STORAGE STRUCTURE WILL BE PLACED (Ii different from
tnallin` address.) 2-7 it tL S Z Z
SUBDIVISION_y —BLOCK N,.,,,,r....,__._.LOT#�
DATES THAT TIM TEMPORARY STORAGE STRUCTURE WILL BE LOCATED ON TIM
PROPERTY: through
/!oT —4C F'( �Ola V e f
ef7lesideotlni property
Q Cowrverclal (Provide survey or site plan showing location where structure will be placed.)
0 Other �L/5? �S �l�K��7 d94���t -
I i-IEREBY CERTIFY THAT ALL INFORMATION PROVIDED IS COICT.
Sigoature of property owner or authorized agent. I
SIGNATURE PRINT NAME
CONTACT INFORMATION OF PERSON SUBNnTTING TMS R$GISTRATION FORM (PLEASE PMI)
NAME
t1A.ILING &DDRESS
11I410NE FAX
The Best Moving A Stornge N Bver
904-378-8485