POD REG 1728 PARK TER JUN-18-2013 11:02 FROM: TO:2475845 P.1
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City of Atlantic Reach 900 Seminole Road •Atlantic Beach,Florida 32233-5445 l!/
Phone: (904) 247-5$00 FAX (904)247- • http:Y/www/ci.at)antic-beach.fl-us /)
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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 sttuctures cannot be looatcd within front yard setbacks and shall not be used to store any chemical,
hazardous,flammable ur combustible rriatcrials, _ ,
r� �y DATE � .���e ' r<
APPLICANT NAME: ! r f
MAILING ADDRESS:
ADDRESS WHERE TEMPORARY STORAGE STRUCTURE WILL BE PLACED (If different from
ma111ng address,)
SUBDIVISION BLOCK# LOT#
DATES THAT THE TEMPORARY STORAGE STRUCTURE WILL Bg LOCATED ON THE
PROPERTY: b—t2 through -1 .2
99
[] Residential property
❑ Commercial (Provide survey or site plan showing location where stru�cturre�will be placed.)
❑ Other ff +r T �
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I HEREBY CERTIFY THAT ALL INFORMATION PROV•IDEWOM storage Idea ave`
Signature of property owner or authorized agent, "4-37&8M
SIGNATURE PRINT NAME
CONTACT INFORMATION OF PERSON SC7'BMITTING THIS REGISTRATION FORM (PLEASE FRiN)
NAME
MATLTNG ADDRESS
PHONE
_------------FAX - A