CITYOFWHITEWATERPARKINGPERMITREGISTRATION
JUNE
1,2020TOMAY31,2021
312W.WhitewaterStreetWhitewater,WI53190262‐473‐0555
Yourlotwillbeassignedinorderinwhichitisreceivedstartingon5/13/2020at8am.
NoEarlyregistrationformsorelectronicpaymentswillbehonored.
Youmusthavethisformwithproofofresidenceemailedtopolice@whitewater‐wi.gov
andpaymentsubmittedbeforeyouareassignedalot.
LastName:_________________________________FirstName:_______________________MI:____
LocalAddress:________________________________________Apt#_______,Whitewater,WI53190
Whataddressshouldthepermittobemailedto?Ifdifferentfromabove:
____________________________________________________________________________________
Phone#:__________________________Email:____________________________________________
LicensePlate#:_________________NameofVehicleOwner:_________________________________
Lotpreferences(EligibleLots:D,E,G,H,J,K,CenterStreet,4
th
Street):
1.________2.________3.________4.________5.________
WhatProofofresidenceisattachedtotheemail?_____________________________________
Whattypeofpaymentwassubmitted? CreditCard Check#____________ Cash(Donotmail)
Whatmethoddidyousubmitthepayment? PSN(online) DropBox PostalService
Downtownemployeepermitholdersonly:
BusinessName&Address_____________________________________________________________
___________________________________________________________________________________
OfficialUseonly:
EmailedFormReceived(date&time):_________________________________________
LotAssigned:
ResidentLot________Permit#____________
DowntownEmpPermit#______ NightOwlPermit#______ EarlyBirdPermit#______
ProofofResidence:
Letter Lease Bill__________________ Other__________________
Paymentreceived(date&time):_________________________________________
Paid$_____________MethodofPayment:
Cash Check#____________ CreditCard
EnteredintotheComputer