Fillable Beach Parking Annual Permit Application Form printable pdf download

Beach Parking Annual Permit Application

(

)

Please Print

Name:

(First, MI, Last)

Business Name:

(If Applicable)

Street Address:

City, State, Zip Code:

Mailing Address:

)

(If different than above

(_____)________________ E-MailAddress:

Phone Number:

Vehicle Tag #2:

Vehicle Tag #1:

(provide copy of registration)

Vehicle Tag #3:

_________________________

(provide copy of registration)

Limit is 3 passes per household. If more than one tag #, please include copy of state registration for each additional

vehicle. Second and third vehicle must be registered to the above address.

COST: $45.00 for a 6 month permit or $75.00 for an annual permit (includes 7% State Sales Tax). Discounts as follows:

Senior Annual Permit: $30.00 for a 6 month permit or $55.00 for an annual permit (includes 7% FL State Sales Tax)

Please note: You must be 65 years of age or older and provide a photocopy of your valid State Driver’s License or State

issued identification. (DOB verified by ___________)

Military Annual Permit: $30.00 for a 6 month permit or $55.00 for an annual permit (includes 7% FL State Sales Tax)

Must present DD-214 Military Discharge paperwork with an honorable or general discharge indicated or a valid Military

Identification Card includes DD Form 2, DD form 1173, DD Form 1173-1 or DD Form 2765. (Discount does not apply to DoD

Civilian Retiree card)

Limited Income Annual Permit: $37.50 for an annual permit (includes 7% FL State Sales Tax) Must show proof of EBT

card or are receiving a limited income senior property exemption.

Disabled Parking Permit/Tag: You are not required to pay the daily or annual fee. Permit must be properly displayed. If

a marked handicapped space is not available you may park in any parking space with the hang tag displayed.

This permit is good at the following Pinellas County Park locations: Fort De Soto Park, 3500 Pinellas Bayway South, Tierra

Verde, Fred Howard Park,1700 Sunset Drive, Tarpon Springs and Sand Key Park, 1060 Gulf Blvd, Clearwater.

PAYMENT METHODS: Money Order, Cash, Check, Credit Card (MasterCard/Visa only) Please do not send CASH through

the mail. *Make check payable to: Pinellas County BOCC. If check is returned by your bank for non-payment you will be

assessed a returned check fee of $30, in addition to the annual permit fee.

CREDIT CARD PAYMENT: Please provide Daytime Phone No. if different than above – We will call you for credit card

information. Daytime phone number: (____) _______________.

Return by mail or in person to: Pinellas County Parks & Conservation Resources Department, Beach Parking Annual Permit,

12520 Ulmerton Road, Largo, FL 33774. Main office hours of operation: Monday-Friday 8 AM – 5 PM - Closed Weekends

and Holidays. Call 727-582-2100 (select 2 from the menu) for additional information.

Annual Permit will be mailed upon receipt of payment or credit card validation. Permit will be valid through the last day of the

month one year from the issue date. The expiration date will be listed on Permit. Parking is on a space available basis;

Permit does not guarantee a vehicle parking space. Permit is NOT transferable. NOT VALID at County Boat Ramp locations.

Signature: ____________________________________________

Date: ___________________________

NEW __________ VOID __________

RENEWAL __________ OTHER __________

DEPARTMENT USE ONLY

_____________

Site Name Where Permit Issued: _________________________________________________________

Date Received

: # ____________

#_____________

#_______________

Permit Number(s)

Exp Date:______________________

□

_______

: __________

: ____________

: _________

Cash

Credit Card

Check #:

Amount Paid

Date Mailed

Staff Initials

Revised 9/29/2015

Beach Parking Annual Permit Application Form

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