CE 900-21 PLAZA 2013 APR-4-2013 12:02 FROM: TO:2475845 P.1/1
City of Atlantic Beach 800 Seminal Road •Atlantic Beach,Florida 32283-5445
Phone: (904)247-5800 FAX (904) 47-M01" , http:/lwww/ci.atlantic-beach.fl.us
S'r qs—
REGIST. . TION FORM
FOR TEMPORARY TORAGE 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. Wi in all residential Zoning Districts, these may be used only for
the temporary storage of personal household belon ings of occupants of the property and may be placed on the
property for a period not to exceed four (4) days or inety-six(96) hours, Registration is required each time that a
temporary storage sla-ucture 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 xtended to ten (10) days upon request to and written approval
of the City Manager. Within all non-residential Zo ing Districts, enclosed portable storage structures may be used
for temporary storage of items related to the rugines located On the property, for a period not to exceed thirty (30)
days. Such structures cannot be located within fro t yard setbacks and shall not be used to store any chemical,
hazardous,flammable or combustible materials. DATE �Z — /� r
APPLICANT NAME: A16'
MAMING ADDRESS:
ADDRESS WHERE NIPOR.A_RY STOP-AGETRUCT IJ DEP CED (If different from
mailing address.) Z—A
SUBDIVISION _BLOCK# LOT#
DATES THAT THE TEMPQRARI! STORAGEtrough
RUCTURE WILL BE LOC TED ON THE
PROPERTY: �� T_
�} Residential property rI
Commercial (Provide survey or site plan shod ng location where structure will be placed.)
[] Other L
I BEREBY CERTITY THAT ALL INFORMATJQ N PROVIDED I
4G
Signature of property owner or authorized agent. The Bess Moving&Storage Idea Ever
904-378- 4$5
SIGNATURE PRINT NAME
CONTACT INFORMATION OF PERSON SUBS TTING THIS REGISTRATION FORM (PLEASE PRINT)
NAME
MAILING ADDRESS
PHONE FAX E-MAIL