City Council Meeting January 13,2010
MEMORANDUM FOR T fcA ?F1C REGULATION
PROHIBITION AGAINS f P. IRKING (es i:epl for the disable)
NAME APPLICANT:
PRIMARY STREET ADDRESS: LOCAT ION SIGNS TO BI POSTED: PERMIT: HOURS:
DAYS:
CAROLYN CALHOUN
951 N. AVERS 951 N.A VERS 75946 ALL
ALL
Walter Burnett Jr, Alderman, 27th ward|1010|
APP1JCA10 M FOR DISAEJIi-D PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BE :OUE COMPLETING THE FORM
75946
An application will not be considered a
• All lines ol the application heve bei
• A check or money order lor S70 00 Please note' The application fee st
• Disability must be permanent as e\ submitted at the lime of appiicatior
• Proof ol residency, in the form of a ~x>p) of your drivers license, state identification, or utility bills are submitted at in* time of application.
mpii ite unless: n cc mpleted in full:
mace payable to the City ol Cnicago is submitted as payment ol the application fee: all b? waived for any person holding a valid, current disabled veterans c-iate iden:ed by a copy of /our valid disabled placard and/or current vend* regisddOon
Completed application forms may be r< facility, or via mail at P.O. Box 8C3100. fee will be billed to you annually Shou 744-PARK (72751
lurn. id lo: the offici! ol your alderman, any City of Chicago Department ol Mevenuu ^hieigo, IL60680-31'H3, ATTN: Disabled Permitting Section. A $25 00 maintenance d yc j have question;; or concerns, please call Oui permit processing division at 312'
i. Date ot Binh
4, Applicant La«;t Name
Oir\iuui-;m \h\ i
late identification Numl; ar
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:v Dnvors License Number
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5. Home Address (primary rcsidoncrl
STKEf NUWOL" :» I MHtETN»»IC
6. Address wrier© signs will bo posted
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7 Phone Numbers
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First Name
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Home
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8 Current Permanent Disabled Placard Nu
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9. Current Liconso Plaic Number
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