REQUEST NO: ____________                            DATE:____________

NAME OF DEPT. OR ORGANIZATIONS

__________________________________________________________

 NAME AND ADDRESS OF CONTACT PERSON

NAME:____________________________   E-mail:__________________

ADDRESS:____________________________________________________

PHONE NO:____________________________ FAX:________________________
                            

SPECIAL REQUIREMENTS

__________________________________________________________

__________________________________________________________

__________________________________________________________

__________________________________________________________

PERIOD OF USE

DATE OF EVENT:______ FROM:_____  TO:_____ 

SITE OF THE EVENT__________________________  

LOT(S) REQUESTED_______________________  

EXPECTED ATTENDANCE_______         NO. OF PERMITS REQUESTED_______

REQUESTER'S SIGNATURE:_____________________________ DATE:________

SIGNATURE OF PARKING SUPERVISOR:________________________________  DATE:_________

OFFICE USE ONLY:
APPROVED ________         DENIED________        REMARKS:______________________________

PERMITS PURCHASED: __________    AMOUNT: _________     INVOICE (   )     CHECK (   )
OVERTIME REQUESTED:            APPROVED (   )        DENIED (   )   
NUMBER OF HOURS: _________

APPROVED OR DISAPPROVED BY: ______________________________________