16082 SW 93rd Ave Tigard High School Area Parking Permit Application
Permit Period. September 2016—june 2018
1. Applicant name: •�,c�;�� .�r�C�'t'1 ,�'T (ticu_ ct
Address:
Tigard, OR 97224 Phone # � '
2. For proof of residency, attach a copy of a utility bill, real estate title or rental contract
including name & address.
3. Attach a copy of the vehicle registration for each parking permit requested.
Each household will receive 1 guest-parking permit. If you would like more than 1 guest-
parking permit, how many would you like?
I agree to use any parking permit(s) assigned to my vehicle(s) only on the specific vehicle it is
assigned by the City of Tigard Police Department, for the purpose, it was issued. Any
parking permit(s) remain the property of the City of Tigard and may be revoked if improper
use is demonstrated. I agree to assign guest parking permit(s) to people only while visiting my
home and surrender any rights if I move. Violation of any of these understandings may result
in cancellation of the parking permit(s). After cancellation, any vehicle(s) found parked in the
permit area bearing said parking permit(s) shall be cited.
Signature Date
Mail this application with proof of residency and vehicle registration(s) to:
Tigard Police Department
THS Area Parking Permits
13125 SW Hall Blvd.
Tigard, OR 97223
Cit,of Tigard Service Address: 16082 SW 93RD AVE
ee UTILITY BILLING Customer Number: 055721-000
13125 SW Hall Blvd. I Tigard, OR 97223 1 1-888-826-7211 Service Type: RESIDENTIAL
TIGARD'S STRATEGIC VISION: "The most walkable connnunio,in the Pacific Northlvest Meter Size: 5/8"
c ii-here people of all ages and abilities enjop healtliv and interconnected lives." Service Dates: 06/27/2016 to 07/25/2016
DUE DATE: August 24, 2016
Billing Summary For an explanation of each charge,please seethe reverse side of this bill.
WATER CHARGES:
Water Consumption 19 CCF (Current Meter Read 4,019 Previous Meter Read 4,000 ) $89.10
Customer Base Charge $26.67
TOTAL TIGARD WATER CHARGES: $115.77
................................................................................................................................................................................................
SEWER AND SURFACE WATER CHARGES:
Sewer Usage Charge Based on your Winter Average of 11 CCF $19.97
Sewer Base Charge $27.36
Surface Water Management Charge $9.75
TOTAL SEWER AND SURFACE WATER CHARGES: $57.08
................................................................................................................................................................................................
OTHER CHARGES:
Residential Street Maintenance $5.30
Residential Parks& Recreation Fee $3.75
TOTAL OTHER CHARGES: $9.05
................................................................................................................................................................................................
Compare Your Water Usage TOTAL CURRENT BILLING: $181.90
CCFS Water consumption is charged per 100 cubic feet(or CCF).Each CCF=748 gallons. PRIOR BILLING:
20 Previous balance(as of July 25,2016): $137.77
16 Adjustments: $0.00
12 Payments received-thank you: -$137.77
TOTAL PRIOR BILLING: $0.00
8
4 TOTAL DUE: $181.90
lal
0
AUG'15 SEP'15 OMS NOW15 DEC35 JAN'16 FEB'16 MAR'16 APR'16 MAY'16 JUN'16 JUL'16
■ Current Year Previous Year Last year's water usage in same billing period: 0 CCF
r----------------------------------------------------------------------I
DISCOVER THE BENEFITS-SKIP THE CLUTTER AND SAVE THE PAPER.WITH OUR CONVENIENT PAPERLESS BILLING YOU RECEIVE YOUR BILL ONLINE AND GET AN 1
1 EMAIL NOTICE WHEN IT'S READY.VIEW YOUR BILL ANYTIME,VIEW PAST BILLS,AVOID LOST OR MISPLACED BILLS AND HAVE THE CONVENIENCE OF SEEING ALL 1
1 THE INFORMATION ASSOCIATED WITH YOUR UTILITY ACCOUNT.IT'S A SUSTAINABLE,EARTH-FRIENDLY CHOICE.SIGN UP AT 1
1 HTTPS://TIGARD.MERCHANTTRANSACr.COM 1
"-----------------------------------------------------------------------1
Please return this portion with payment.Please DO NOT staple or tape check to the coupon.
ElFOR CHANGE OF ADDRESS,PLEASE CHECK BOX AND COMPLETE FORM ON REVERSE SIDE.
City of Tigard I UTILITY BILLING
as 13125 SW Hall Blvd.
Tigard,OR 97223 DUE ATE: August 24, 2016
TOTAL UE: $181.90
ADDRESS SERVICE REQUESTED Service Address: 16082 SW 93RD AVE
Customer Number: 055721-000
2016 1 AV 0.376 5/282 02043 0001:0001 Make check payable to:City of Tigard.
III'I"111111'I�Ill�llll�ll�lllll�r�ll�llll'111'1"111111"'III" 503-718-2460 www.tigard-or.Roy
MELISSA
BLAKE MASONRADO
III I Iln III III III IIII I I I n II Inl III II
16082 SW 93RD AVE
TIGARD OR 97224-5560 CITY OF TIGARD
P.O. BOX 3129
PORTLAND,OR 97208-3129
101055721000000000000181903
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