1654 Main POD Application 12-2012 p I m � `off
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City of Atlantic Beach - 800 Seminole Road -Atlantic Beach,Florida 32233-5445
Phone: (904)247-5800 - FAX (904)247-5805 - http://www/ei.atlantic-beach.fl.us
REGISTRATION FORM
FOR TEMPORARY STORAGE STRUCTURES
Portable storage structures may be used within the City of Atlantic Beach following submittal of this completed
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 the
property for a period not to exceed four (4) days or ninety-six (96) hours. Registration is required each time that a
temporary storage structure is placed on the property. In the event of damage to a residence by fire, storm, flood,or
other such property loss, this period of time may be extended to ten (10) days upon request to and written approval
of the City Manager. Within all non-residential Zoning Districts, enclosed portable storage structures 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 chemical,
hazardous, flammable or combustible materials.
DATE 12/Z 7,�l Z.
APPLICANT NAME: ��/ �Z /��/7 j /7 Ate- aI T
MAILING ADDRESS: Z 47 5�1 /I'I /94/V a T
ADDRESS WHERE TEMPORARY STORAGE STRUCTURE WILL BE PLACEDdifferent from
mailing address.) Z S :77-74- �`7– Ax g G4
SUBDIVISION BLOCK# LOT#
DATES THAT THE TEMPORARY STORAGE STRUCTURE WILL BE LOCATED ON THE
PROPERTY: /Z /Z 9 through / '
0 Residential property
❑ Commercial (Provide survey or site plan showing location where structure will be placed.)
❑ Other
I HEREBY CERTIFY :HAT AL O TION P OVIDED IS CORRECT.
Signature of properly own or th rize agent.
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SIGNATURE � PRINT NAME /"/ �Z �C��n her
CONTACT INFORMATION OFF PERSON SUBMITTING THIS REGISTRATION FORM (PLEASE PRufr)
NAME /'� Z 1L�� N AA r.I_r
MAILING ADDRESS
PHONE FAX E-MAIL