1728 W Park Ter POD JUL-2-2013 06:50 FROM: TO:2475845 P.1/1
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City of Atlantic Beach 800 Seminole Road •Atlantic Beach,Florida 32233-5445
Phone: (904) 247-5800 FAX (904)247.5"- http://www/cl.atiantic-boach.1l.us
5-914/�
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 (1.0) 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 loeatcd within front yard setbacks and shall not be used to store any chemical,
hazardous,flammable or combustible materials, 2
DATE
APPLWANT NAME: b'-p—
XA):LXNG
ADDRESS:
ADDRESS WHERE TXM'>P'ORARY STORAGE STRUCTURE WILL BE PLACED (If different from
mailing address.)
SUBDIVISION BLOCK# LOT#
DATES THAT THE TEMPORARY STORAGE STRUCTURE WILL BE LOCATED ON TIE
PROPERTY; �)`•- ?__t--„=I I_� through
Residential property
Commercial (Provide survey or site plan showinglocationwhere structure will be placed.)
❑ Other LG-1
I I-M,RJ 0V CERTIFY THAT ALL INFORMATION PROVIDED IS U09FIENZWeg&Storage Ides Ever
Signature of property uwner or authorized agent, 904-37&440
SIGNATURE PRINT NAME
CONTACT INFORMATION OF PERSON SUBMITTING THIS t EGISTRATI FORM (MeAsr FwNT)
NAME
MAILING ADDRESS
PHONE FAX E-MAIL