APPUCATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWINGi CAREFULLY BEFORE COMPLETING t^E K>RM
72706
An application will not be considered complete unless:
AH lines of the appfacafion have been compteted in full;
■ A check or money onier for S70.C0 made p'iayaibia to the City of Chicago te submitted as payment of The applicator* fse: Pi*asr; now: Trio application fee shall Be waived for any person holding a valid, current diri&bled veterans plate. Disability must be permanent as evidenced by a copy ol your valid disabled placard and/or current voliirto regiairuiion submitted at the lime oi application;
Proof of residency, in the form of a copy of your drivers !lccf>3_. tjrtaite' irjf^tllicatbn. ot utility bids are submitted at ?h<i "irire of application.
Compl«li»d. application forms may be returned to; the office of your alderman, any City ol Chicago Department of Revftnuip facility, or via .mail at P.O. Box 803100. Chicago. 'IL .6G680-31OO. ATTN: Disabled Permitting Section. A $25 OC ma*ntewvic4i fee will be bided to yoy annually. Should you tiave auestions or concerns, please call our permii orocessino rjiviwon at 312-7.54-PARK {7275).
i, o' Birth
\ Z. State Idcnilfiraiicn Number
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i. Applicant laat Name
1 3 Drivers Ucenso Number
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5. Home Addies* (primary nwiconca)
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6. Addmos whom sign*\vtHbfiposted .-tai >unqc^ : ' urn. | m'nrr.THitve
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7. Ph'jnQ Numbers
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j P. Ci>;ren\: Permanent. Disabled Plac.-ird Number
9. Current License Plate Numbor
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Hugisiered to Pw.viir.«is^ip lo Applicant
Registered to
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/oof* 25
10. Description ot Medicikl Condition and DisabHin
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Altornrjiivr? Parking: Pioasn nolo your application may be denied II you hnvc altcnp»tlva SoooMlbla oB-<itr©<?t porWr^p oplior>:»
FWat'rmahip to Apjflcori!
SjZL?............__________I
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; i Ir. iri(ir» oft-tlnwl pat king .variable? al your primary KKidtorc ().<■ gawge. car port, drivaway, etc.)''
12 if vow answered Ye» to ques'.<on 11. pleas, describe:
-1 Garage: □ Orivirwev. -I Car Port; □ Other;
"J YES jj3 NO
13. Is your oH'stretit paiMng aecesfiibie? □ Yob; J_i P'ense explain:
14. Affirmation: I hereby tffllnn iti_t the ab&v* irifcrtnetion it truo end correct. Il.the City el Chicago Oeporimerrt or Re^anua tfateirmlno. mai the applicant fras lalMly fepresented orte or more of the above conditions, tt>e ajsplicent shalff be tu/0)oci io n fmo of no! lesa ttan $100 but no more inan $500, and the ap'pticaiton than be denied. I also understand thai it ib my lesponsiUiiy to noWy ihe peportmem of Revenue ot any cftangas in tne informetiun provided.
Signature t<C^M}^*(flf
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□ COMPLETE
FOR OFFICE USE ONLY
City of Chicago Richard M, Daley, Mayor
Department of Revenue
BetReyna-Hickcy Director
City Hall. Room 107A 121 North LaSalle Street Chicago. Illinois 60602-1288 (312) 747-1747 (IRIS) (312) 744-0471 (FAX) (312) 744-2975 (TTY)
January 12,2011
CHARLES L ERVIN 8226 S WOLCOTT AVE CHICAGO. IL 60620
Dear Applicant.
The Department of Revenue has recommended installation of disabled parking 6igns near your residence. Based on this recommendation, the signs for your restricted parking space will be installed. However, your application must be approved by City Council. If the proposed ordinance is not passed within four months after Its introduction, the permit shall be revoked and the restricted parking signs removed.
The parking permit must be renewed annually. The fee is $25.00. A renewal notice will be mailed one year from the date the signs are installed.
Please be advised that you are required to report any changes to the Information provided on your original application to the City of Chicago Department of Revenue. You are also required by City law to notify the Department if you no longer meet the following permit qualifications:
* You must hold either a valid, current disabled veteran's state registration plate or permanent person with disability license plate, permanent parking placard or device authorized by the Illinois Vehicle Code:
" Any vehicle parked by you or for you in the designated area must bear the disabled license plate, permanent disabled parking placard or devices issued lo you by the State of Illinois;
* You must continue to reside at the home address listed on the original application.
A residential disabled parking permit will be issued to you by the City of Chicago. It must be placed on the right side of the dashboard. Only qualified vehicles displaying the permit are authorized to park in your restricted parking space. The permit number must be visible from outside your vehicle. The permit will be Installed at:
Address/Location of Signs: 8226 S WOLCOTT AVE Permit number. 75873
Should you have any questions or require additional information, please contact the City of Chicago's Helpline at 312.742.7434.
Very truly yours,
Anthony Gambino Manager of Parking
Copy: ALDERMAN LANE
City of Chicago Richard M. Daley, Mayor
Department of Revenue
Bea Reyna-Hickey Director
City Hall, Room 107A 121 North LaSalle Street ChicagD, Illinois 60602-1288 (312) 747-4747 (IRIS) (312) 744.0471 (FAX) (312) 744-2975 (TTY)
January 12, 2011
ALDERMAN LONA LANE WARD 18 8146 S KEDlZIE CHICAGO, il 60652
Dear ALDERMAN LANE:
The Department of Revenue recommends installation of disabled parking signs as described below. The application has been reviewed and a survey of the location has been conducted. Since the applicant has met the requirements outlined in the Municipal Code, the signs will be installed.
Provided is the name and address of the applicant, the exact location proposed for the signs, and the permit number assigned. Please introduce ari ordinance to post residential disabled parking signs at the location recommended, if one has not yet been introduced
Applicant's Name: CHARLES L ERVIN
Applicant's Address: 8226 S WOLCOTT AVE
Address/Location of Signs: 8226 S WOLCOTT AVE
Permit Number: 75873
Work OrderNumber: WlO-lHHO
If the proposed ordinance is not passed within four months after its introduction; the permit shall be revoked and the restricted parking signs removed. Should you have any questions or require additional information,:please contact our office at 312.742.7434.
Very truly yours,
Anthony Gajmbino Manager of iParking
Enclosure: Disabled Signs Application