The undersigned is applying for a DELIVERY PERMIT.  Under Title 16 (Vehicle Code), a vehicle bearing this permit may:

OCCUPY A 15 MINUTE METERED SPACE FOR NOT MORE THAN FIVE (5) MINUTES, AND ANY OTHER METERED SPACE FOR NOT MORE THAN TWENTY (20) MINUTES WITHOUT PAYMENT OF METER FEE.

Applicant may also occupy two (2) SPECIFIED truck loading zones/locations for maximum of 30 minutes.

1). _________________ on N S E W side of street between ___________ and ___________.
              (Street Name)                                                                                   (Cross Street)               (Cross Street)

2)  _________________ on N S E W side of street between ___________ and ___________.
              (Street Name)                                                                                   (Cross Street)               (Cross Street)

This permit must be clearly displayed in the lower center of windshield when service is performed. This permit remains the property of the City of Portland and must be surrendered upon demand by any authorized officer.  THIS PERMIT MAY NOT BE USED IN ADDITION TO TIME ON THE METER.

Violators of these conditions shall be penalized as follows:

Failure to surrender a suspended permit within 10 days of the date of our notification to you will result in the cancellation of the permit for the remainder of the year.  Continued noncompliance may result in an examination of whether permits will be issued to you in the future.

Signed by: _____________________________________________________
                            (Firm/Agency Representative)

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