2. The installation of a handicapped parking space does not restrict the handicapped parking space to only the person requesting the space but is accessible to anyone with a handicapped license plate or placard.
4. First Name of Handicapped Resident*
5. Last Name of Handicapped Resident*
7. Property Address 1*
9. Property Address 2
11. City*
12. State*
13. Zip*
15. Phone Number*
16. Email Address
18. Does the handicapped resident own the property?*

    1. Yes
    2. No
20. If NO, please provide the name, address, and telephone number of the property owner:
22. Please describe the location to be designated as a handicapped parking space:*
24. Does the handicapped resident have access to off-street parking such as a driveway or garage?*

    1. Yes
    2. No
26. If YES, please describe the off-street parking and explain why the handicapped resident does not use the off-street parking:
28. In order to utilize a handicapped parking space, a motorist must have a handicapped license plate or placard.*

    1. License Plate
    2. Placard
30. List the handicapped license plate or placard number.*
32. Please provide any additional information that may be of assistance to the Traffic Engineering Committee and the City Council members when they review your request:
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit Submit and Print

* indicates a required field