1915 SEA OATS DR POD REG OCT-2-2013 05:56 FROM: TO:2475545 P.1
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City of Atlantic Beach ' 800 Seminole Road Atlantic Beach wiorlda 32233-5445
Phone(904) 7 58Oq,:l..FAX"'�40sI).2:47.5885 • http://ww itlantic-beach-fl.us
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R.EGISTRATION FORM
FOR TEMPORARY STORAGE STA
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Portable storage structures may be used within the, City of Atlantic Beack Following submittal of this completed
form to the Building and Zoning Department. Within all residential-Zoning Vlstricts, 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 tv:r. �ecd" o�ui°( d'k�.a or'ncty-six (9 6) hours. Re
gistration is required each time that a
temporary storage structure is placed on the property. 7n the event of damage to•a residence by fire, storm, flood, or
other such property loss, this period of time may be exteaded to ten (10).days upokrequest to i nd-written approval
of the City Manager. Within all non-residential Zoning'Djttricts, enclosed portable storage structures may be used
for temporary storage of items related to the business located on the pr6party,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,
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hazardous, flammable or combustible materials.
DATE , flc-T
APPLICANT NAME: 111 '
MAILING ADDRESS: . , '' •
A.DDRESS VYI EI MPORARY STORAGE STRCIC ' WILL BE PT22.
CED (If different from
tndlling address.) S__ C.�/ 7'. ., .3
SUBDIVISION BLOCX# .R ..;_ LOT#
DATES THAT TIDE TEMPORARY STORAGE STRIJPUIE WILL HE 1;0CATED ON THE
PROPERTY: ,,Uo— 2— throogh,� rc ?. "I-3
esidectial property f
❑ Commercial (Provide survey or site plan showing location wsere srfucture-will be placed.)
❑ Other
I IUREBY CERTIFY THAT ALL INFORMATIONTIRO VSDEIy T� "j'hs g �Ian EverSignature of property owner or authorised agent. t 901-3784W5
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SIGNATURE P1y'I:"NAMT
CONTACT INFORMATION OF PERSON S'CTl3kliT NG"I'M'IS GISTRA 40' N FORM (PLEASE PRR T)
NAMF
70.9
MA.LLING ADDRESS
I'I I O NE PAX
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