Disabled Parking Application for Individuals

Disabled Parking Application

for Individuals

Use this form to apply for disabled plates, placards and/or tabs. Once you and your healthcare provider have

completed each section, take this application AND A SEPARATE signed authorization from your healthcare

provider to any vehicle licensing office or mail to any location from the attached page.

Applicant

PRINT or TYPE Name (Last, First, Middle initial) Date of birth (mm/dd/yyyy)

Mailing address (PO Box or street address and apartment number, if applicable) City State ZIP code

10-digit daytime phone Email

Current license plate, if applicable Registration expiration, if applicable

Applicant or authorized representative signature

Parking privilege options

Your healthcare provider will determine if you get temporary or permanent disabled parking.

• Temporary placard – valid for 1 year or less. Only one placard will be issued (no fee required). A new

application is required to renew.

• Permanent disabled parking – valid for 5 years. You must be the registered owner of the vehicle that has

permanent plates or tabs. Before your privilege expires, we will send you a renewal notice.

Permanent disabled parking choices (choose only one)

Placard only – no fee required

Number of placards:

1 2

Permanent plates –fee required (see dol.wa.gov for current fees)

Select one: 1 placard and 1 set of license plates

1 set of license plates

Disabled parking tab for specialty or personalized plates – fee required

(see dol.wa.gov for current fees)

Select one:

1 disabled parking tab

1 placard and 1 disabled parking tab

Disabled parking tab for WATV – fee required (see dol.wa.gov for current fees)

Select one: 1 disabled parking tab

1 placard and 1 disabled parking tab

You will receive an identification (ID) card 2 to 4 weeks after we process your application. Keep it with you to

show law enforcement, if asked.

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When completed, print this form and sign here.

Healthcare provider – Doctor, physician, or licensed registered nurse practitioner fills out this section.

You must provide a separate signed authorization stating: (1) the applicant’s name and (2) they have a

condition which qualifies them for disabled parking privileges. This authorization must be on prescription

paper or your office letterhead. If this application is printed on prescription paper, it meets both the

application and authorization requirements. Return this form and your signed authorization to the applicant.

PRINT or TYPE Name Professional classification Professional license number

Office address (Street address, City, State, ZIP code) 10-digit phone number

Privilege duration

Permanent

Temporary for:

months (up to 12 months)

Answer the following

My patient meets one of the following qualifying conditions:

• Cannot walk 200 feet without stopping to rest or must use assistive device

• Walking severely limited due to arthritic, neurological,

or orthopedic condition

• Uses portable oxygen or walking restricted by lung disease

• Class III or IV impairment by cardiovascular disease

• Acute sensitivity to auto emissions that limits ability to walk

• Legally blind with limited mobility

• Restricted by porphyria (applicant benefits from a decrease in exposure to light)

I declare under penalty of perjury under the law of Washington that the applicant named above has a medical

necessity that severely affects mobility or involves acute sensitivity to light.

Date and place (city or county) signed MD, DO, DC, DPM, ND, ARNP, or PA ONLY signature

A parking permit for a person with disabilities may be issued only for a medical necessity that

severely affects mobility or involves acute sensitivity to light (RCW 46.19.010). An applicant or

healthcare practitioner who knowingly provides false information on this application is guilty of

a gross misdemeanor. The penalty is up to 364 days in jail and a fine of up to $5,000 or both. In

addition, the healthcare practitioner may be subject to sanctions under chapter 18.130 RCW, the

Uniform Disciplinary Act.

RCW 46.19

WAC 308-96B-010, 308-96B-020

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Healthcare provider signs here

Please mail your completed Disabled Parking Application to one of the following locations:

Adams County Auditor

210 W Broadway Ave Ste 200

Ritzville, WA 99169-1860

Asotin County Auditor

PO Box 129

Asotin, WA 99402-0129

Benton County Auditor

PO Box 470

Prosser, WA 99350-0470

Chelan County Auditor

350 Orondo Ave Ste 202

Wenatchee, WA 98801-2885

Clallam County Auditor

223 E 4th St Ste 1

Port Angeles, WA 98362-3000

Clark County Auditor

PO Box 9812

Vancouver, WA 98666-8812

Columbia County Auditor

341 E Main St

Dayton, WA 99328-1361

Cowlitz County Auditor

207 4th Ave N

Kelso, WA 98626-4193

Douglas County Auditor

PO Box 341

Waterville, WA 98858-0341

Ferry County Auditor

350 E Delaware #2

Republic, WA 99166-9747

Franklin County Auditor

PO Box 1451

Pasco, WA 99301-1223

Garfield County Auditor

PO Box 278

Pomeroy, WA 99347-0278

Grant County Auditor

PO Box 37

Ephrata, WA 98823-0037

Grays Harbor County Auditor

100 W Broadway Ste 2

Montesano, WA 98563

Island County Auditor

1 NE 7th St

Coupeville, WA 98239-3105

Jefferson County Auditor

PO Box 563

Port Townsend, WA 98368

King County Licensing

201 S Jackson St # 206

Seattle, WA 98104-3854

Kitsap County Auditor

614 Division St

Port Orchard, WA 98366-4614

Kittitas County Auditor

205 W 5th Ave #105

Ellensburg, WA 98926-2891

Klickitat County Auditor

205 S Columbus Ave Rm 203

Goldendale, WA 98620-9280

Lewis County Auditor

PO Box 29

Chehalis, WA 98532-0029

Lincoln County Auditor

PO Box 28

Davenport, WA 99122-0028

Mason County Auditor

PO Box 400

Shelton, WA 98584-0400

Okanogan County Auditor

PO Box 1010

Okanogan, WA 98840-1010

Pacific County Auditor

PO Box 97

South Bend, WA 98586-0097

Pend Oreille County Auditor

PO Box 5015

Newport, WA 99156-5015

Pierce County Auditor

2401 S 35th St #200

Tacoma, WA 98409-7460

San Juan County Auditor

PO Box 638

Friday Harbor, WA 98250-0638

Skagit County Auditor

PO Box 1306

Mount Vernon, WA 98273

Skamania County Auditor

PO Box 790

Stevenson, WA 98648-0790

Snohomish County Auditor

3000 Rockefeller Ave MS 506

Everett, WA 98201-4060

Spokane County Auditor

PO Box 2351

Spokane, WA 99210-2351

Stevens County Auditor

215 S Oak St, Rm 104

Colville, WA 99114-2847

Thurston County Auditor

3000 Pacific Ave SE

Olympia, WA 98501-8809

Walla Walla County Auditor

PO Box 1856

Walla Walla, WA 99362-0356

Wahkiakum County Auditor

PO Box 543

Cathlamet, WA 98612-0543

Whatcom County Auditor

PO Box 398

Bellingham, WA 98227-0398

Whitman County Auditor

400 N Main St

Colfax, WA 99111-2031

Yakima County Auditor

PO Box 12570

Yakima, WA 98909-2570

Department of Licensing

Applications & Issuance

PO Box 9043

Olympia, WA 98507

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