POD REG 662 SELVA LAKES CIR OCT-30-2013 07:15 FROM: TO:2475845 p,1
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13 - 3
City of Atlantic Beach • 800 Seminole Road •Atlantic Beach,Florida 32233-5445
Phone.4904)247-5900 - ITAX (904)24'j.-680 , - http://www/cl,ptlantic-beach.fl.us
REGISTRATION FORM '
FOR TEMPORARY STORAGE STRUCTURES
Portable storage strucraca 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
properry for a period not to-exceed fou.
.(4) days or.iaincty-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 Yequest to sLtd-written approval
of the City 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_.22_ f
APPLICANT NAME:
MAILING ADDRESS:
ADDRESS WIMRE WORARY STORAGE =f BE FL CED different from
hzdlling address,) ,.�•
SUBDTVISION 31-2 ,���� � LOT#
DATES THAT TEM TEMPORARY STORAGE STRUCTURE WELL BE LOCATED ON TEMPROPERTY: _O� v C7"" throagb � �^- ,•tI'c�G..�
esidential property
C1 Commercial (Provide survey or site plan showing location where structure will be placed.)
13 Other
I HEREBY CERTIFY THAT ALL MORMATION PROVDE `N"jp%>k Sterane Ides Ever
Signature of property owner or authorized agent. "4-3784WW if C
l�
SIGNATURE PRINT NAME
CONTACT INFORMATION OF PERSON SUBMYTTING TMS REGISTRATION FORM
(PLEASI»PRL�'r?
NAME
MAILING A.DDRESS
PRUNE_ FAX E-N1A