Fillable Form 13120 Newsrack Application (Town of Fort Myers Beach)

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Form 13120 Newsrack Application (Town of Fort Myers Beach)

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Town of Fort Myers Beach
News Rack/Box Inventory for Registration
Pursuant to Ordinance 17-14
Revised 2/27/2018 Town of Fort Myers Beach Page 1 of 1
2525 Estero Blvd., Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Permits@fmbgov.com Fax: 239-765-0909
Company Name: ______________________________________________________________________________________________________________
Phone Number: _____________________________________________________________________________
Street Address: ________________________________________________________________________________________________________________
City: _________________ State: ___________ _____ Zip Code: _____________________________
Emergency Contact Email Address: __________________________________________________________________________________________
Insurance Information
Insurance Company:
Phone Number:
Policy Number:
Insurance Agent:
Phone Number:
Address:
City, State, Zip Code:
Item
#
Proximity/
Location
House
#
Street Name
Closest Cross
Street
Notes
Town of
FMB
Assigned
Number
1
Front
2
Rear
3
Across from
4
Looking at Left
5
Looking at Right
6
North Side
7
South Side
8
East Side
9
West Side
TOTAL
EX:
Front
2525
Estero
Tropical
Shores Way
Yellow Box
2018-00001
You can submit the completed form via mail to: Town of Fort Myers Beach
2525 Estero Boulevard
Fort Myers Beach, FL. 33931
For any questions, please call: (239) 765-0202 ext. 1307
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Form 13120 Newsrack Application (Town of Fort Myers Beach)

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Completed 18 July 2020

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