Yarra Council PO Box 168 Richmond VIC 3121 T 9205 5555 F 8417 6666 TTY 133 677 then ask for 9205 5555
Interpreter Services 9280 1940 E info@yarracity.vic.gov.au W www.yarracity.vic.gov.au
Parking permit application form
Parking in Yarra - July 2020 to June 2021
PAGE 1 OF 2
APPLICATION INFORMATION
APPLICANT DETAILS All applicable sections must be completed
VEHICLE DETAILS For residential, business and medical permits only
PERMIT TYPE Please tick all relevant boxes
Please complete all sections of this application form and return together with
payment and supporting documentation to the Yarra City Council.
This application form is for new permit applicants only. If you have
previously held a residential parking permit please contact us to ensure that
you are still eligible for parking permits, or to arrange for a renewal notice or
a replacement permit application.
One application is to be completed per person.
Please refer to the parking permit policy for conditions. Signing this
application is deemed to be acceptance of the policy which is legally binding.
For further information please visit www.yarracity.vic.gov.au/parking
Residential or visitor permit (only one visitor permit per household)
*
The following cardholders are eligible for the concession rate: Health Care Card, Department of Veterans’ Affairs Gold Card, Pensioner, War Widow and TPI concession cards.
First permit Resident or Visitor $41 (full) FREE (concession
*
)
Second permit Resident or Visitor $100 (full) $41 (concession
*
)
Third permit: pre-existing entitlement only
QUESTION 1 Are you a current resident at the property? Yes No
QUESTION 2 Has there been a change of ownership or tenancy after 21/10/2014? Yes No
*
*
You must supply supporting documentation to prove ownership or tenancy prior to 21/10/2014. Refer to the parking permit policy for further details.
Third permit Resident Visitor $188 (full)
$41 (concession
*
)
Business permit
First permit $137 Second and subsequent permits (as per allowance) $254
Medical Practitioner permit
**
**
If the permit is for attendance at Epworth or St Vincents hospital hospitals you must have authorisation completed that is on the reverse of this page.
First permit $137
Second permit $254
Temporary resident permit
Temporary permits are free and valid for one month. Please nominate the date you would like the permit to start from.
Only one temporary permit will be issued in a 12 month period.
Temporary resident permit
First name Last name
Registration State Vehicle make Vehicle type
Registration State Vehicle make Vehicle type
Registration State Vehicle make Vehicle type
Business name (if applicable)
Address Suburb
State Postcode
Email
Home phone Work phone Mobile
Number of permits
Starting date
Vehicle one
Vehicle two
Vehicle three (pre-existing entitlement only)
GO TO QUESTION 2
ELIGIBLE FOR THIRD PERMIT
NOT ELIGIBLE
NOT ELIGIBLE
Yarra Council PO Box 168 Richmond VIC 3121 T 9205 5555 F 8417 6666 TTY 133 677 then ask for 9205 5555
Interpreter Services 9280 1940 E info@yarracity.vic.gov.au W www.yarracity.vic.gov.au
Parking permit application form
Parking in Yarra - July 2020 to June 2021
MEDICAL PRACTITIONER AUTHORISATION Applicable only for applications for a Medical Practioners’ permit
Full name Position
Name of applicant
Signature Date
This section must be completed by authorised staff member of hospital in attendance.
By completing this section you are stating that the Medical Practitioner below is in your opinion, entitled to receive a Medical Practitioners’ permit.
Hospital in attendance Epworth St Vincent’s
ACCOMPANYING DOCUMENTATION
If you are claiming the exemption from the first residential/visitor permit fee or concession rate for
second/third permits, your application must include a copy of your current Health Care Card, Department
of Veterans’ Affairs Gold Card, Pensioner, War Widow or TPI concession card.
PRIVACY INFORMATION
The personal information requested on this form is being collected by Yarra City Council for the purpose
of assessing your permit application in accordance with the Local Government Act 1989. The Council will
use this information only for that purpose or for directly related purposes.
You may apply to Council for access to your personal information or to amend the same. If you do not
provide this information your permit application cannot be processed.
DECLARATION
I have read and agree to the Parking policy. A copy can be obtained online at www.yarracity.vic.gov.au or by calling 9205 5555.
Print name Date
Signature
PAYMENT
Payment can be made by cash, eftpos or credit card at one of our Customer Service Centres, Monday to Friday 8.30am to 5pm.
Please note a surcharge of 0.5% applies for credit card payments. American Express is not accepted.
Richmond Town Hall 333 Bridge Road, Richmond
Collingwood Town Hall 140 Hoddle Street, Abbotsford
Connie Benn Centre 160 Brunswick Street, Fitzroy
Bargoonga Nganjin, North Fitzroy Library 182 St Georges Rd, North Fitzroy
Alternatively, you can post your completed application form and payment by cheque or money order to Yarra City Council, PO Box 168, Richmond VIC 3121.
Before posting or attending a Customer Service Centre, please ensure you have:
provided proof of residency / business provided proof of registration
read and sign the declaration included a cheque or money order
PAGE 2 OF 2
