CE 467 SELVA LAKES CIR MAY-4-2013 08:13 FROM: TO:2475843 P.1
City of Atlantic Beach $00 Seminole Bnad Atlantic Beach,Florida 32233-5445
Phone: (904)247.5800 • FAX (904)247•!0f&• http.,//www/Ci.2tlantle-beach.1l.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 (95) hours. Registration is required each time that a
temporary storage structure is placed on the property. Tn 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 he 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,flanunable or combustible materials.
//yy DATE - A
APPLICANT
NAME: 4 CCC A—
MAILING ADDRESS:
ADDRESS WHERE TF PORARY STORAGEnUCTURE�L BE PLA�E�D�different from
mailing address.) _ Grf ,
SUBDIVISION BLOCK# ..._...._LOT##
DATES THAT THE TEMPOIt�RY STORAGE STRtJC*rURE WILL BE LOCATED ON THE
PROPERTY; �' through F�
esldeutial property
Q Commercial (Provide survey or site plan showing location where structure will be placed.)
Other
I HEREBY CERTIFY THAT ALL INFORMATION PROV'ID5i1orage bl"Ever
Signature of property owner or authorized agent. 904-378-
SIGNATURE PRINT NAME
CONTACT INFORMATION OF PERSON SUBMITTING THIS REGISTRATION FORM (PLEASE PRINT)
NA1V >r
MAILING ADDRESS
PHONE FAX EMAIL ..