City of Berkeley Customer Service Finance Deartment

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					            Residential and Visitor                                                         Residential and Visitor
                City of Berkeley
          Parking Permit Application                                                            City of Berkeley
                                                                                          Parking Permit Application
  Customer Service Finance Deartment
   City of Berkeley - Customer Service Finance Department                         Customer Service Finance Deartment
                                                                                   City of Berkeley - Customer Service Finance Department
                      1947 Center St., Berkeley, CA 94704                                             1947 Center St., Berkeley, CA 94704
          PH:(510) 981-7200 • FAX:(510) 981-7210 • TDD: (510) 981-7250                    PH:(510) 981-7200 • FAX:(510) 981-7210 • TDD: (510) 981-7250

 Residential Parking Permit Application
       Annual Permit    Visitor Permit                                           Residential Parking Permit Application
                                                                                       Annual Permit    Visitor Permit
   ALL APPLICANTS:                     DATE:                                       ALL APPLICANTS:                     DATE:


   NAME: LAST                                  FIRST                     M.I.      NAME: LAST                                  FIRST                     M.I.


   STREET ADDRESS                                            APT#                  STREET ADDRESS                                            APT#
   BERKELEY, CA                                                                    BERKELEY, CA
   CITY,                 STATE                 ZIP                                 CITY,                 STATE                 ZIP
         SEE BELOW FOR                                                                   SEE BELOW FOR
           Driver’s License/
         LICENSE PLATE                                                                     Driver’s License/
                                                                                         LICENSE PLATE
       State ID Number
   DRIVER’S LICENSE #                          HM PHONE                                State ID Number
                                                                                   DRIVER’S LICENSE #                          HM PHONE


                                               WK PHONE                                                                        WK PHONE

         TYPE OF PERMIT APPLYING FOR:                                                    TYPE OF PERMIT APPLYING FOR:
                  All permits require Photo ID and                                                All permits require Photo ID and
              proof of residence to the Berkeley address.                                     proof of residence to the Berkeley address.

    1-day Permit                                                                    1-day Permit
                      • up to 20 blank per resident                                                   • up to 20 blank per resident

    ______ X $2.00 = $__________                                                    ______ X $2.00 = $__________
    14-day Permit                                                                   14-day Permit
                     • 3 per year per resident;                                                      • 3 per year per resident;
                      • license plate and dates of use required;                                      • license plate and dates of use required;
                      • must start within 3 weeks of issue                                            • must start within 3 weeks of issue

    ______ X $20.00 = $__________                                                   ______ X $20.00 = $__________

    License Plate #1:____________#2:_____________                                   License Plate #1:____________#2:_____________
    Annual Permit - price varies due to pro-ration                                  Annual Permit - price varies due to pro-ration
                      • vehicle registration to Berkeley address                                      • vehicle registration to Berkeley address
                              required;                                                                       required;
                      • if the vehicle is registered to another                                       • if the vehicle is registered to another
                              person, add’l documentation required                                            person, add’l documentation required

    License Plate #:___________ X $___.___                                          License Plate #:___________ X $___.___

    License Plate #:___________ X $___.___                                          License Plate #:___________ X $___.___
(if required) VIN:                                                              (if required) VIN:


    TOTAL DUE: $_________
    TOTAL               TENDER :
     DUE: $____________ CA CK CR                                                    TOTAL DUE: $_________
                                                                                    TOTAL               TENDER :
                                                                                     DUE: $____________ CA CK CR
     OFFICE USE ONLY                                         AREA                    OFFICE USE ONLY                                         AREA
    1P                                                                              1P

    4P                                                                              4P

    PP                                                                              PP