9385 SW Julia Pl �P-aII ,� Dla
Tigard High School Area Parking Permit Application
Permit Period: September 2016 -June 2018
1. Applicant name:
Address: /C��� J/)L M
Tigard, OR 97224 Phone # S03 9 2 Y A3 Z-2
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 receiveOarking.permir:, If you would like more than 1 guest-
parking permit, how many w like? .2—
I
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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.
11 / cif
Signatu e 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
13125 SW Hall Blvd. 1 "Tigard, OR 97223 1 1-888-826-7211 -- -
Meter Size: 5jf
• I'MARD'S STRATEGIC VISION: "The most walkable comumrih hi the Pacific Xorthirest
inhere people of till ages crud abrkries cnjgr healtln'rrrrd inter'carmectccllices. Service Dates: 06/27/2016 to 07/25/201
DUE DATE: August 24, 201
Billing Summary For an explanation of each charge,please see the reverse side of this bill.
WATER CHARGES:
Water Consumption 6 CCF (Current Meter Read 1,949 Previous Meter Read 1,943 ) $20.70
Customer Base Charge $26.67
TOTAL TIGARD WATER CHARGES: $47.2
..............................................................................................................................................................................................
SEWER AND SURFACE WATER CHARGES:
Sewer Usage Charge Based on your Winter Average of 2 CCF $3.63
Sewer Base Charge $27.36
Surface Water Management Charge $9.75
TOTAL SEWER AND SURFACE WATER CHARGES: $40.i
..............................................................................................................................................................................................
OTHER CHARGES:
Residential Street Maintenance $5.30
Residential Parks&Recreation Fee $3.75
TOTAL OTHER CHARGES: $9.(
...............................................................................................................................................................................0.0...0.0.....0.
Compare Your Water Usage TOTAL CURRENT BILLING: $97.1
CCFS Water consumption is charged per 100 cubic feet(or CCF).Each CCF=748 gallons. PRIOR BILLING:
15 Previous balance(as of July 25, 2016): $101.9
12 Adjustments: $O.a
9 Payments received-thank you: -$101.9
6 TOTAL PRIOR BILLING: $0.0
3 TOTAL DUE: $97.1
0
,
AUG'15 SEP'15 OCPSS NOV'15 DEC35 7AN'16 FE016 MAR'16 APW16 MAT16 IUN16 1UL'16
■ Current Year Previous Year Last year's water usage in same billing period: 10 CCE
DISCOVER THE BENEFITS-SKIP THE CLUTTER AND SAVE THE PAPER.WITH OUR CONVENIENT PAPERLESS BILLING YOU RECEIVE YOUR BILL ONLINE AND GET AN
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 THE INFORMATION ASSOCIATED WITH YOUR UTILITY ACCOUNT.IT'S A SUSTAINABLE,EARTH-FRIENDLY CHOICE.SIGN UP AT
1 HTTPS://TIGARD.MERCHANTTRANSACT.COM
Please return this portion with payment.Please DO NOT staple or tape check to the coupon.
❑FOR CHANGE OF ADDRESS,PLEASE CHECK SOX AND COMPLETE FORM ON REVERSE SIDE.
City of Tigard I UTIi.rrN'B11AANG
13125 SW Hall Blvd,
Tigard,OR 97223 DUE DATE: August 24, 2016
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TOTAL DUE Autopay-Da Not Pay
ADDRESS SERVICE REQUESTED Service Address: 9385 SW JULIA PL
Customer Number: 009996-000
2111 1 AV 0.376 51377 02138 0001:0001 Make check payable to:City of Tigard.
503-718-2460 www.tig-ard-or.gov
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JON &SUSAN SKYBERG
9385 SW JULIA PL 'III'IIIIIIII'III'll'II'll'III'1'IIII'IIIIII�I�IIIII'l1I'lI1�lI�1
TIGARD OR 97224-5593 CITY OF TIGARD
P.O. BOX 3129
PORTLAND,OR 97208-3129
101009996000000000000097162