Permit POD 1981 Mipaula Ct 2010 JLL-5-2010 10:26 FROM: TO:2475845 P.1
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City or Atlontic Beach goo Semtnolo Road •Atlantic Basch,Florida 32233-5445
Phone: (904) 247-5600 FAX (904)2474M • http:li"w/el.atlantle-boach.n.us
2 y7'
. REGISTRATION FORM
FOR TEMPORARY STORAGE STRUCTURLIS ;
'Portable storage structures may be used within the City of Atlantic Beach following 'submittal of this completed
form to the wilding and Zoning Department, Within all residential Zoning Distracts, these may be used only for
the temporary storage of personal household belongings of occupants of the property and may be placed on t"nc
property for a period not to exceed four (4) days or ninety-six(96) hours. Registration 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
othcr such property loss, this period of time may be extended to ten (16) days upon request to and-writteri approvai
of the City Manger. Within all non-residential Zoning Districts, enclosed portable storage structures may be used
(or temporary storage of items related to the business located on the property, for o period not to exceed thirty 00
days. Such structures cannot be located within front yard aetbaeks and shall not be used to stare tiny chemic:i
hater0us, flammable or combustible materials.
r� DATE _�—iC/ 2 a�_2_-Vzl,Q_...�.---
APPUCANTNaME: atc—
MAILING ADDRESS:
p6DDRESS WH=ERE TEMPORARY STORAGE STRUCTURE WUX BE�PLAC D (If dUferent from
knAding address.)
SUBD1viSION BLOCK 4
DATES THAT THE TEMPORARY S STRUCTURE WILL STRUCTU WILL BE LOCATED ON THE
PROPERTY: 7 �r through
E*-11tesideutial property 11411 q �
Q Commercial (Provide survey or site plats showing location where structure will be placed.)
0 Other
I aREBY CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT.
Signature of property owner or authortxed &Scot,
SIGIr'ATURE PRINT NAME
CONTACT INFORMATION OF PERSON SUBMITTING T9XS REGISTRATION FORM (PLW9?Mn
h4AILINC &DDRESS
PRONE FAX
Jacksonville FL 32,220
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