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2. Applicant Name*
3. Email Address*
5. Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
12. Fax Number
14. Permit Description
    Longfellow Street Overnight Parking: Pursuant to Brunswick Town Ordinance Sec. 15-71 (14), Longfellow Street Overnight Parking Permits may only be issued to owners of property on Longfellow Street. No more than two may be issued to a property owner. The permits are not vehicle specific and may be used by the property owner, their tenant or a guest of the owner or tenant. The permit must be hung from the rear view mirror when a vehicle is parked on the street between 1AM and 6 AM. Page Street Overnight Parking: Pursuant to Brunswick Town Ordinance Sec. 15-71 (14), Page Street Overnight Parking Permits may only be issued to owners of property on Page Street. No more than two may be issued to a property owner. The permits are not vehicle specific and may be used by the property owner, their tenant or a guest of the owner or tenant. The permit must be hung from the rear view mirror when a vehicle is parked on the street between 1AM and 6 AM.
16. Permit Requested*
    -- Select One --Longfellow ST Resident ParkingPage ST Resident Parking
17. No. of Permits Requested?*
    -- Select One --12
19. Street Address of Property for Which Permit is Requested*
21. Certification of Ownership*

    By checking the "I agree" box and typing my name below, I certify that I am the owner of the property for which the permit is requested.

    1. I agree.
23. Electronic Signature*
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field