HomeMy WebLinkAboutTM rev 2nd Draft Parking Permit ApplicationCITY OF CAPE CANAVERAL RESIDENT BEACH END PARKING PERMIT
EFFECTIVE PERIOD – TO DECEMBER 31, 2012
Provide all information requested on the form and return to City Hall via mail or in person, 105 Polk Avenue, P. O. Box 326, Cape Canaveral, FL 32920-0326, Attention: Finance Office.
REQUIREMENTS: In addition to the completed application, submit a copy of your Driver’s License (or Government Issued ID) and a copy of your current vehicle registration FEE: ______________________
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PLEASE TYPE OR PRINT CLEARLY
NAME: __________________________________________________________
STREET ADDRESS: _______________________________________________
CITY AND STATE: _______________________________________________
POST OFFICE AND ZIP: ___________________________________________
VIN#/VEHICLE/MAKE/MODEL/YEAR: ______________________________ LICENSE PLATE NO: _______________
I HEREBY CERTIFY THAT I RESIDE AT THE ADDRESS SET FORTH ABOVE; I AM THE OWNER OF THE MOTOR VEHICLE HEREIN AFTER DESCRIBED; I HEREBY MAKE APPLICATION FOR A BEACH END PARKING PERMIT TO
PARK SUCH MOTOR VEHICLE IN ACCORDANCE WITH CITY ORDINANCE NO. ____________. I AGREE THAT THE CITY OF CAPE CANAVERAL AND ITS EMPLOYEES, OFFICERS AND AGENTS SHALL NOT BE HELD LIABLE
FOR ANY LOSS OF, OR DAMAGE TO ANY VEHICLE OR PERSONAL PROPERTY, OCCURRING WHILE SUCH VEHICLE OR PERSONAL PROPERTY IS LOCATED AT ANY METERED BEACH END PARKING SPACE.
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SIGNATURE OF APPLICANT
For Notary use only: State of __________, County of __________
Sworn and subscribed before me this ____ day of _______________, 20____, by __________________________
Printed name of Applicant
who produced identification: _______________________ or
is personally known to me.
Seal: ________________________________________________ Signature - Notary Public At Large