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2. Instructions
   Submit this form to gain access to disabled parking at Meadowdale Beach, and Lake Cassidy. The Parks Department will contact you within 2-3 business days with the access code(s) applicable to the requested park.
4. First Name*
5. Last Name*
7. Address1*
9. Address2
11. City*
12. State*
13. Zip*
15. Email
16. Phone1*
17. License Plate No.*
19. Is your Disability
    -- Select One --PermanentTemporary
20. Date of expiration
    Date of expiration
21. If temporary, please explain:
23. Which park(s) are you requesting access to?

    (check all that apply)

    1. Lake Cassidy
    2. Meadowdale Beach
24. Attach a scanned copy or photo of one of the following:*

    1. A current disabled parking permit placard

    2. A current set of disabled parking decals

    3. A current set of disabled person license plates

26. By submitting, you are agreeing to the following:
    1. The code will not be used by anyone other than me.
    2. All Washington State and Snohomish County ordinances will be followed.
    3. Parking decals, permits, or plates will be properly displayed while inside the boundaries of the County Park.
    4. Parking will be in designated stalls only.
    
    I understand that any violation of list above or unauthorized use of these privileges may result in revocation of parking access.
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field