Request for Parking Permit

Please fill out and return this form to the City of Durango, 949 E 2nd Avenue, Durango CO 81301, Parking Division. Payment must accompany each request. Please allow 4-6 days for receipt of permits via US Mail.
Name:
Address:
City:
State:
Zip Code:

	Quantity	Month/Year	Cost Each	Total
Please specify number of permits requested for each month.		July 2004	$ 15.00
		August 2004	$ 15.00
		September 2004	$ 15.00
		October 2004	$ 15.00
		November 2004	$ 15.00
		December 2004	$ 15.00
		July through December 2004	$ 90.00
	NOTE: No refunds will be considered. No replacements will be made for lost or stolen permits.