City Council Meeting January 13,2010
MEMORANDUM FOR T RA FFIC REGULATION
PROHIBITION AGAINS I P \RKING (ei ccpi: for the disable)
NAME APPLICANT
PRIMARY STREET ADDRESS: LOCATION SIGNS TO B i POSTED: PERMIT: HOURS:
KJ;CIA Y PERNELL
]] 54 N. SPRINGFIELD 1154 N.SPRINGFIELD
75945
ALL
DAYS:
ALL
Walter Burnett Jr, Alderman, 27th ward
V
APPLICATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BEI Of !E COMPLETING THE FORM
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Art i!;.;i>lu:;tliori ',vtil r>f.( tie (.oni.idc reo-ex npltio Liivicpy All linas ol ih<> application .-.aw b«k4 i conp'eteo ir. ii.ii:
AChcH.*: or nio'wiv iir6,;:i' k'r S?Q 00 rwd. ;.iiiy.'!itilc to !'■■<: <'. rty ot Chicago is submitted as payment a' th* Stpptolwu* tee,
f'-'esse now. T f\» application tee sh I' b* waived for any j: arsor holding a vald, curront dissarw-ri vote-ran* plan?
Disability rnutft Lit' permanent as ev Jerv ed by a copy of > our v rid disables f.fia«:aic- a/idtor curx-c! vr.'iiew :etywz\w>,
tfuli-rnitteO ;:U ilit time or :ation:
l'*iooi- of Ktfietoricy. in th« iotm ol a i opyor youi duvois !ic?ns<». slate idenllliivitian. or yiiliiy rjilis uia submitted at t::v.; ii;rifc mi application.
Coinpisti?t1 upp!i(i»tirin tiwiw) i'ri;:iy oc; iei irne i ic ihfc ntlioe of /om ttldennat;. any City Cnicago Depa:t."»vs^; ci1 flevwrut' teoii'.y. o: via inail a? P.O. Box BCMOO. < hicejn,. IL 00fcj9C::i 10 j. 4T"N: Oisaoleo IVimittiny Section. A $25.00 rnawH\br.ur.t:t! Ie<s v/tit tiiilcio w yc-iJ annually. Should y«. nave questions nr ix«rce«os, pteasw* -an our perron processing division at 3" 2-74-l-PARK fV2''S>.
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l-i Attn Italian i hereby atfirm llicl Ilia abovo iJont ution is true ura ci nw. It U'6 Cily ol CrtKlago Department oi Rumriut' dben^rai thai Ihe applicant hits relsoly rtspreienutJ oik r mt -e oi lite above an (tiiio- t... the appkarn snail be subject to u fin.j ol «oi ic»f, irwn Si00 hi:i no more t»wn $500, nnd the appiiraii' n un ill be duniod. I ni<ji- u-iOe:stand irmi ii is my respotw.oility to "oi'iy <M rJoiKirinicm im Rov.vmui! of aivy change* in lhe inloima"ion pr< 'Wee
Date
FOH OFFICE U£« OfoLY
□ I 'LAOARO/PLATE
C^RESIDENCY CJ COMPLETE ff~yy^.