POD 330 COUNTRY CLUB JUL-10-2013 09:55 FROM: TO:2475845 P.1
3
City of Atlantic Beach 800 Seminole road •Atlantic Beach,Florida 32233-5445
Phone: (904)247-S$00 PAX (904)247-900• http://www/cl.stlantie.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. Witivn 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 materials. err f
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APPLICANT NAME: A P4
MAILING ADDRESS:
ADDRESS WHERE TEMPOWY STORAGE STRUCTURE WELL BE PLACED (if different from
mailing address.) 3 3CP e44 .3 -�—ZJ
SUBDIVISION BLOCK# LOT#
DATES THAT TRE TEMPORARY ySTOR4GE STRUCTURE WILL BE LOCATED ON THE
PROPERTY: 214- 7#2- hrough
,12"Rtrsidential property
Q Commercial (Provide survey or site plan showing location where structure will be placed.) x`23
❑ Other
W
I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED ff W StoraEe Idea Ever
Signature of property owner or authorized agent. 9"37&ws
SIGNA'T'URE PRINT NAME ^_
CONTACT INFORMATION OF PERSON SUBMITTING TMS REGISTRATION FORM (PLL ,sz rmr)
NAME
MAILING ADDRESS
PHONE ''ASC E-MAIL