Fillable PERMIT PARKING APPLICATION (White Plains, NY)

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PERMIT PARKING APPLICATION (White Plains, NY)

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CITY OF WHITE PLAINS
DEPARTMENT OF PARKING
255 Main Street - Annex Building, White Plains, NY 10601 ● 914-422-1232
PERMIT PARKING APPLICATION
NAME
EMAIL
ADDRESS
CITY
STATE
ZIP
PHONE (HOME)
(Work)
PERMIT INFORMATION
LOCATION
PERMIT TYPE
VEHICLE INFO: MAKE
MODEL
GROSS WEIGHT
PLATE / STATE
☐
☐
VEHICLE EXCEEDS HEIGHT Y
☐
N
☐
RESIDENCY PROOF
Resident Only permits require the following three (3) proofs of residency for purchase (all documents must have
same name and address)
1. Valid NY Driver’s License (must show resident parker’s name and a City of White Plains address)
Name on License:
Expiration date:
2. One of the following: (must be presented for verification)
☐House Deed ☐Property Tax Bill ☐Lease ☐Utility Bill (current in parker’s name)
3. Vehicle Registration (one for each plate number listed on permit with same information as license)
☐Plate #1: ☐Plate #2:
Important: please read prior to signing
a. Conduct by a permit holder or permit applicant which, in the City of White Plains, Department of Parking’s judgment, endangers the
health, safety, or welfare of the public shall constitute grounds for denial of the permit application and possible revocation of the
permit.
b. Conduct by any permit holder or permit applicant which is abusive, belligerent, or threatening to employees, or conduct which is
deemed to be illegal shall also constitute grounds for the denial of a parking permit or for the revocation of a permit.
c. A permit is a revocable license subject to termination at the City of White Plains, Department of Parking’s discretion upon refund of
remaining permit value.
d. The City of White Plains, Department of Parking does not guarantee that a parking permit will be available or issued upon proper
completion of an application.
e. Conduct by the permit holder or permit applicant which violates or has violated the City of White Plains, Department of Parking’s
Rules and Regulations shall constitute grounds for denial of the parking permit or for the revocation of the parking permit. Any
payment remitted for the purposes of obtaining a parking permit will be refunded to the applicant upon denial of the application or
upon revocation.
f. Issuance of a parking permit does not guarantee an automatic right of renewal.
I, the permit applicant, have read the above and am fully aware of the City of White Plains, Department of
Parking’s Rules & Regulations.
Permit Holder Signature:
Date:
Print Name:
FOR OFFICE USE ONLY
WP DOP STAFF VERIFICATION:
COMMENTS:
Revised: 3/11/14
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PERMIT PARKING APPLICATION (White Plains, NY)

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Completed 5 August 2020

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