CE 1590 BEACH AVE SEP-27-2013 08:44 FROM: TO:2475845 P.1/1
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City of Atlantic Beach $00 Seminole Rood -Atlantic Beach,Florida 32233.5445
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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 toc0e67four,`;(4'wclays:ar'ninery-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 (14).days upon;request to 4.nd-written approval
of the Cury 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 located within front yard setbacks and shall not be used to store any chemical,
hazardous, flammable or combustible materials.
DATE 2
e-
APPLICANT NAME: A l !� f1
MA-MING ADDRESS:
ADDRESS WEBRE E PORARY STORAGE STRUCTURE L BE PLACED (If different from
malting address,) f tp /�a�/,� f-( /�de-
I 11 I�r b��� IMII rW I- TIAF I
SUBDIVISION BLOCK# LOT#
DATES THAT THE TEMPORARY STORAGE STRUCTURE WILL BE LOCATED ON THE
PROPERTY,. through '-36�'-"C'3
Residential property
❑ Commercial (Provide survey or site plan showing location where.sttucture will.be placed.)
❑ Other
I HEREBY CERTIFY THAT ALL INFORMATION FROYID7tlBIds,Ever
Signature of property owner or authorized agent. 904-3M
SIGNATURE PRINT NAME
CONTACT INFORMATION OF PERSON SUBMITTING THIS REGISTRATION FORM (PLEASE PRtlr"r)
NAME
MAILING ADDRESS
PHONE FARC EMAIL