CE 869 OCEAN BLVD JUL 0 2 Z013
City of Atlantic Beach - 800 Seminole Road Atlantic Bea -
Phone: (904)247-5855 - FAX (904)247-5845 www.coab.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 (96) hours. Registration is required each time that a
temporary storage structure is placed on the property. 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 located within front yard setbacks and shall not be
used to store any chemical,hazardous, flammable or combustible maerials. / 3
DAT
APPLICANT NAME:
MAILING ADDRESS:
ADDRESS WHERE TEMPORARY STORAGE STRUCTURE WILL BE PLACED (If different from
mailing address)
SUBDIVISION BLOCK# LOT#
DATES THAT THE TEMPORARY STORAGE STRUCTURE WILL BE LOCATED ON THE
PROPERTY: a1 J 3 through ? �'� 173
E Residential property
❑ Commercial (Provide survey or site plan showing location where structure will be placed.)
❑ Other A, t 4
T
I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT. ^\�
Signature of property owner or authorized agent.
SIGNATURE
� PRINT NAME
CONTACT INFORMATION OF PERSON SUBMITTING THIS REGISTRATION FORM (PLEASE PRINT)
NAME �r� �
�G�� �, ,Dl v '. �t C e� c-41 / 3,2_?-33
MAILING ADDRESS S�9 G�
PHONE ��y�'7 y_ /3 7 FAX c7l 0 `� a 7-3- O FF 3 E-MAIL
C�
Revised May 2012