APPLICATION FOR MISCELLANEOUS RESIDENTIAL PARKING ZONE (RPZ) PERMIT

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First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Email Address

Phone Number *

Miscellaneous Residential Parking Zone (RPZ) Permits

The City of Ellensburg offers miscellaneous RPZ permits. Each of the four permits is briefly described, below.
CONTIGUOUS TO THE RPZ

A resident who lives contiguous to the RPZ may request one RPZ permit.
THREE DAY TEMPORARY GUEST PERMITS

A resident who lives in the RPZ may request three day temporary guest permits for a specified period of time.
SERVICE PROVIDER PERMITS

A service provided located in the RPZ and providing services to residents in the RPZ may request up to 2 RPZ permits.
BUSINESSES IN RPZ

Business located in the RPZ may request 2 permits plus additional permits equal in number to the average full time worker employed at the business (up to 2). NOTE: the formula to determine the number of full time workers is: total part time hours normally worked by all employees each month divided by 173.

My application is for (check one) *

Contiguous to the RPZ

Businesses in RPZ

Service provider

Three day temporary guest pass

FOR THREE DAY TEMPORARY GUEST APPLICANTS

Service provider applicants must provide the following information - Company or business name and the type of service provided

Service provider has a City business license?

Yes

No

Service provider requests parking permits in the following zones:

Zone 1

Zone 2

Both Zones 1 & 2

For business applicants, please specify the number of permits requested, the number of worker permits requested (per formula, above), and the number of additional permits requested.

# of permits requested

# permits for workers

# add'l permits requested

Vehicle Information. Provide the following information for each vehicle parked in the RPZ.

	Vehicle #1	Vehicle #2	Vehicle #3
Year	Vehicle #1	Vehicle #2	Vehicle #3
Make	Vehicle #1	Vehicle #2	Vehicle #3
Model	Vehicle #1	Vehicle #2	Vehicle #3
Ext color	Vehicle #1	Vehicle #2	Vehicle #3
License #	Vehicle #1	Vehicle #2	Vehicle #3
State	Vehicle #1	Vehicle #2	Vehicle #3

Style of permit *

Rearview mirror hanger

Windshield sticker

Style of permit

Rearview mirror hanger

Windshield sticker

Style of permit

Rearview mirror hanger

Windshield sticker

AFFIDAVIT

I acknowledge I live in the Residential Parking Zone. I have been provided the opportunity to examine Chapter 8.54 of the Ellensbur4g Municipal Code and I am familiar with the terms thereof.

PROOF OF RESIDENCY Upload one of the following documents as proof of residency: Utility account in applicant's name; lease agreement in applicant's name and with RPZ address; or a copy of your driver's license in applicant's name and with RPZ address. *

Sign and date *

clear

Electronic Signature Option

NOTE: If submitting this form electronically, please type your name and date on the corresponding lines above. Please review the electronic submittal disclaimer, and check box to acknowledge.
ELECTRONIC SUBMITTAL

By placing your typed initials in the box, typing your name and date in the applicant/citizen signature field, and submitting this form electronically, I CERTIFY that all the information I am providing on this form is true and correct to the best of my knowledge. I also understand that my electronic signature is legally binding as if I were physically signing the form. I understand that any material misrepresentation, omission or falsehood may result in rejection or nullification of my application.

Place your initials in the box below *