POD 30 ARDELLA RD 2013 FEB-27-2013 12:01 FROM: TO:2475845 P.1
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City or Atlantic Beach 800 Seminole Road Atlantic Beach,Florida 32233-5445
a http;//www/cl,ittlantio-beach.n.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 ternporary storage of personal household belongings of occupants of the property and may be placed on the
property for a period not t *(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 pruperty loss, this period of time may be extended to ten (10).days upon,,rccluest to Apd--written approval
of clic Crry Manager. Within all non-residential Zoning Districts, enclosed portable storage structures may be used
for temporary storage of items rcfated 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 a used t store any chernic:al,
hazardous, flammable or combustible materials.
DATE &� I
APPLICANT NAKE: #A7 4jz17,e j441 4-4
MAILING ADDRESS;
ADDRESS WHERE TEMP RARYS ORAGEST UCT WILL BE PLACED (If different from
hndl,ling address.) 10 Q
SUBDIVISION- �0C/4 AQ P►ISO'-.BLOCK# LOT#
DATES THATTHE TEMP/O� � 'Y STO GE STRUCTURE WILL BE LOCATED ON TBE
PROPERTY: r. — r � r through
residential property
❑ Commercial (Provide survey or site plan showing location where structurq.w-iMD `
EDOther
8498 Mallory Road
I HEREBY CERTIFY THAT ALL INFORMATION PRO'VWED IScOMRIonville, FL 3=0
Signature of property owner or authorized agent,
,
SIGNATURE PINT NA11 dc'e'ft'1/17
CONTACT INFORMATION OF PERSON SUBMITTING TMS REGISTRATION FORM (?LEASE eWT)
N AME
MAILING .A..DDRESS
PHONE FAX E-MAXL