9262 SW Martha St G PIMP-
SC-003
'F-17-c>0/4
Tigard High School Area Parking Permit Application
Permit Period. September 2016-June 2018
1. Applicant name: ����n �� �Zb 5e-
Address: SLl) � -Ax.Ct St.
—
Tigard, OR 97224 Cic; Phone # '3,2- 5L4S
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�. _ij
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: I
Tigard Police Department
THS Area Parking Permits
13125 SW Hall Blvd.
Tigard, OR 97223
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View Bill Page 1 of 2
City of Tigard, Oregon
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BIII
City of Tigard
13125 SW Hall Blvd
Tigard,OR 97223
503-718-2460
8:00am-6:00pm
Account Information
Account: 028806-001
Name: DEBORAH ROSE
Service Address: 9262 SW MARTHA ST
Service Period: 7/2/2016 to 7/29/2016(28 days)
Billing Date: 8/3/2016
Due Date: 8/24/2016
Meter Reading
Previous Reading Current Reading
Serial Date Reading Date Reading Cons
6745 6/27/2016 2933 7/25/2016 2936 3
Current Charges
Water: $0.00
Water:518 Residential Consumption $10.35
Water: 5/8 Residential $26.67
Sewer: Base Charge Consumption $7.26
Sewer: Base Charge $27.36
SWM:Surface Water Mgmt $7.75
SWM:Tigard SWM Surcharge $2.00
Street Maint Fee: Residential Fee $5.30
Park Maintenance Fee: Residential Fee $3.75
Total Current Charges: $90.44
Bill Summary
Previous Balance: $90.10
Payments Received: $90.10
Adjustments: $0.00
https:Htigard.merchanttransact.com/secure/viewbill.aspx 8/12/2016
PASSENGER REGISTRATION CARD I•IEW EXPIRATION DATE
PLATE NUMBER TITLE NUMBER FUEL TYPE FARM ID NO. JAN 5 , 2018
328FHU 1412674930 GASOLINE
HVUT DATE
YEAR MAKE STYLE �z3
EL VEHICLE IDENTIFICATION NUMBER FEE
2010 MAZD 4D JMIBLISG1A1294813 �
EQUIPMENT NO. WEIGHT/LENGTH TITLE BRANDS _ NONE - $86 . 00
ODOMETER READING ODOMETER DATE ODOMETER MESSAGE O
C
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'vFt,�if. •lim�arii QU,d
-ROSE, DEBORAH
9262 SW MARTHA ST COUNTY OF RESIDENCE COUNTY OF USE
TIGARD OR 97224-5576 WASHINGTON
NEW ADDRESS(HOUSE NUMBER,STREET,CITY,STATE,ZIP CODE)
VAL �t
HEW PLATE NUMBER