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POD REG 1177 ATLANTIC JUL-16-2013 13:40 FROM: TO:2475845 P.1/1 j City of Atlantic Beach 800 Seminole Road •Atlantic Beach,Florida 32233.5445 Phone: (904)247-5800 FAX (904)247-5805'- http://www/ci.atlantic-ho4ch.tl.tis REGISTRATION FORM FOR. TEMPORARY STORAGE STRUCTURES Portable storage structures may be used within the City of Atlantic Beach fpllowing submittal of this completed form to the Building and Zoning Department. Within all residential Zoning bistricts, 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 tip a residence by fire, storm,flood,or other such property loss, this period of time may be extended to ten (1.0) daysapon request to and written approval of the City Manager. Within all non-residential Zoning Districts, unclosed portable storage structures may be used for temporary storage of items related to the business located on the p ,Ifor a period not to exoced thirty(34) days. Such structures cannot be located within front yard sotbacks and shall not be used to store any chernical, hazardous,flammable or combustible materials. HATE � )�„ APPLICANT NAGE: �r4..C J MAILING ADDRESS: ADDRESS WHERE TEMPORARY STORAGE STRUCTURE WILL WPLACED (If different from mailing address.) —Z/2) A14– 610-6 i SUDDI V,I.SION BLOCK# LOT# DATES THAT THE TEMPORARY STORAGE STRUCTURE WILL BE;LOCATED ON THE PROPERTY: /�v through 2 _ v( i ❑ Residential property Commercial (Provide survey or site plan showing location where structure will be placed.) © Othcr rS /2 4- S r r'7 I IMREBY CERTIFY THAT ALL INFORMATION PROVIDED IS( 6M! V44ftft fit semilm idea fiver Signature of property owner or authorized agent. _ SIGNATURE PRINT NAME CONTACT INFORMATION OF PERSON SUBMITTING THIS REGISTRATION FORM (PLWZ PR[N1) NAME MAILING ADDRESS PHONE FAX X-MAIL