FRANK OLIVO
Alderman, 13th Ward
6500 S. Pulaski Road - 60629 Telephone: (773) 581-8000
CITY COUNCIL
CITY OF CHICAGO
COUNCIL CHAMBER SECOND FLOOR. CITY HALL 121 NORTH LASALLE STREET
TELEPHONE: (312) 744-3076
COMMITTEE MEMBERSHIPS
AVIATION - COMMITTEES RULES and ETHICS FINANCE
LICENSE and CONSUMER PROTECTION BUDGET TRAFFIC CONTROL and SAFETY ZONING
January 4, 2011
Honorable Patrick O'Connor Chairman
Committee on Traffic Control and Safety 121 N. LaSalle Street, Room 300 Chicago, IL 60602
Dear Chairman O'Connor:
I wish to override the following application for handicapped parking signs:
3920 W. 69th Street - #73164
Your assistance with this matter will be greatly appreciated. If you have any questions, please call Shari Knight at (773) 581-8000.
With kindest personal regards, I remain
Sincerely,
cm***
Frank J. Olivo Alderman, 13th Ward
*>ts»r'
BEFORE COMPLETING THE FORM
APPLICATION FOR DISABLED PARKING SIGNS jgg^ 73164 PLEASE READ THE FOLLOWING CAREFULLY xr
An application will not be considered complete unless; /^L^<^?^-:^ • All lines of the application have been completed in full; l^J*r^-*<2'k7
A check or money order for S70.G0 made payable to the City of Chicago is submitted as payment of Ihesappiicatior) fee; JPIease note: The application lee shall be waived for any/person holding a valid, current disabled veterans plate. Vr Disability musl be permanent as evidenced by a copy of your valid disabled placard and/or current Vehicle registration submitted at the time of application; •/VProof of residency, in the form of a'copy of your drivers license, state identification, or utility bills are submitted at the time of application.
Completed application forms may be returned to: the office of your alderman, any City of Chicago Department of Revenue facility, or via ma:l at P.O. Box 803100, Chicago, IL 60680-3100, ATTN: Disabled Permitting Section. A S2S\00 maintenance. '' fee will be billed to you annually. Should you have questions ot concerns, piease call our permit processing division at 312' 7 744-PARK (7275).
|
| 1. Date of Birth \ 2. State Identification Number
■oh7*>TnlsTy l5i^acjdoisi^R!^ |
3. Drivers License Number |
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4. Applicant Last Name ' j Ml
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| First Name 1
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5. Home Address (primary residence)
STREET NUMBER lilH. SI^ET MAUE
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6. Address where signs will be posted
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7. Phone Numbers
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Home
Business
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3. Currcnl Permanent Disabled Placard Number j Registered to
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Relationship to Applicant
Current License Plate Number
Registered to J__ City Sticker No.
Relationship to Applicant Cj L f^&F
10. Descnp&pn ol Medical Condition and Disability
Alternative Parking: Please note your application may be denied if you have alternative accessible off-street parking options.
11.1s tnere off-stroet parking available at your primary residence (i.e., garage, car port, driveway, etc.}?
J NO
12. If you answered Yes to question 11, please describe:
yj Garage; □ Driveway: J Car Port; □ Other:
13. Is your olf-stree □ Yes;
&
^/Jarkrng accessible?
• No. Please explain: ft) Q 0 Q ^ pj (j^ u^
14. Affirmation: ! hereby affirm that the above information is true and correct. H the City of Chicago Department ol Revenue determines thai the applicant has falsely represented one or more of the above conditions, ihe applicant shall be subject to a fine of not less than 5100 but no more than $500, and the application shall be denied, i also understand thai it is my responsibility lo notify the Department of Revenue ol any changes in the information provided.
Signature _
Date
FOR OFFICE USE ONLY
□ FEE
PLACARD/PLATE
cVre:
RESIDENCY
□ COMPLETE