Emergency Permit Application

SECTION A - BUSINESS INFORMATION

Business Name:

Address:

City/State/Zip:

Is this address also your mailing address?

Yes

Mailing Address (if different):

City/State/Zip:

Telephone Number:

Contact Name:

Type of Business or Service Rendered:

Number of Visits Involved:

Have you previously been issued a permit?

Yes

Have you ever been denied a permit or had one revoked?

Yes

If yes, explain:

SECTION B - VEHICLE INFORMATION

Vehicle Make

Year

License No.

Do you require another Vehicle to register?

Yes

Vehicle Make

Year

License No.

Do you require another Vehicle to register?

Yes

Vehicle Make

Year

License No.

Do you require another Vehicle to register?

Yes

Vehicle Make

Year

License No.

Do you require another Vehicle to register?

Yes

Please input the Vehicle make, year, and license no. separated by a comma. Then press enter to register another vehicle.

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I acknowledge that the requested permit(s) will be utilized pursuant to Sacramento City Code (SCC). Any Violation of the Parking Permit regulations or applicable SCC section dealing with parking will be sufficient cause for revocation of permits. Permit holders are allowed to park IN THE ALLEY ONLY for as long as it takes to complete their emergency job or service.