Temporary No-Park Self Verification

Self-Verification of Temporary No Parking Zone

* required
Reason for Temporary No Parking Zone:
	* Reason:
	SDOT Permit#(s):
	Other:

Temporary No Park Zone Location:
	* Project Address:
	Area of Town:
	* Sign(s) Located On:	* Block #:
	* Side Of (Street, Ave, Etc):
	To (if multiple blocks):	Block #:
	Side Of:
	* Number of signs:	(Signs are suggested at least every 30 feet.)
	* Install Date:	* Time Installation Completed:
	Signs must be placed at least 72 hours in advance of effective date.

No Parking Zone Effective Dates:
	* Start Date:	* End Date:
	* Daily Start Time:	* Daily Stop Time:
	* Include Saturday?	* Include Sunday?

Party Responsible for Self-Verification:
	* Company Name:
	* Contact Name:	* First: * Last:
	* Street:
	* City:	* State:
	* Zip:
	* Phone Number:		* Email:

* Please list the Contact Phone Number posted on the signs:

* required
	I Certify under penalty of perjury under laws of the State of Washington I verified that the temporary no parking signs were properly and accurately installed, notified the public of the temporary no parking zone, and provided a minimum of 24 hours notice of the temporary no parking zone.

	SDOT Traffic Permits (206) 684-5086
	Police Non-Emergency (206) 625-5011
	Customer Service Bureau (206) 684-CITY