APPLICATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
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An application will not be considered complete unless: ■ All lines ol the application have been completed in full:
A check or money prder lor S70 00 made payable to the City ot Chicago is submitted as payment of the application lee: Please note: The application fee shall be waived for any person holding a valid, current disabled veterans plate
Disability must be permanent as evidenced by a copy of your valid disabled placard and/or current vehicle registration submitted at the time of application;
Proof of residency, in the torm 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 mail at P.O. Box 803100. Chicago. IL 60680-3100. ATTN: Disabled Permitting Section. A $25.00 maintenance fee will be billed to you annually. Should you have questions or concerns, please call our permit processing division at 312-_ __744-PARK (7275). ,
1. Date of Birth 2. State Identification Number
/ MO _ l)»V ___. YEAH _ _
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4. Applicant Last Name
3. Drivers License Number
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5. Home Address (primary residence)
STREET NUMBER Ola I STHEET HH*$ h. .
Ml 1 First Name
,| ZIP CODE
6. Address where signs will be posted
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, WAHO NUMOEn
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7. Phone Numbers Home m i3t |
Business ^|3 I i T i I 7 i i i |
8. Current Permanent Disabled Placard Number |
Registered to |
Relationship to Applicant |
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9. Current License Plate Number |
Registered to » |
City Sticker No. ' 5oi fcSaS |
Relationship to Applicant |
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10 Description of Medical Condition and Disability / x*v
Alternative Parking: Please note your application may be denied if you have alternative accessible off-street parking options.
11. Is there off-street parking available at your primary residence I i.e. i garage, car port, driveway, eic.)?
J YES 34*5
12. K you answered Yes to question 11, please describe: ■J Garage: □ Driveway: J Car Port: J Other:
13.1s your off-street parking accessible?
□ Yes;
□ No. Please explain:
if i&iK. I1.
Affirmation: I hereby affirm that the above information is true and correct. If the City of Chicago Department ol Revenue determines lhat the applicant has falsely represented one or more ot the above conditions, the applicant shall bo subject to a tine of not less than $100 but no more than $500. and the application shall be denied. I also understand that it. is my responsibility to notify the Department of Revenue of any changes in Ihe information provided.
Signature
Date
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FOB OFFICE USE ONLY
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Account Number 6321729010
N»nw FLOMNT1NO BAPCIA
Serve* Location 33»W LEMOYNE ST UNIT 2.01
CHCAOO PrtMe Number 77>690-8»C
Previous Balance Total Paymenta
Amount Due on December 20,2010
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Cuatoowr Charge Standard Metering Charge Otstriburton FactMlea Charge
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Smart Mater Program Envrrorrrnental Cost Recovery Adj Energy Eftloency Programs franchise. Coat State Tax Municipal Tax
Total Current Charge*
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Account Number 6321726010
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ComEd PO Box 6111
Carol Stream, il 601974111
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City orChicago Richard M. Daley, Mayer
December 16, 2010
Dejrartmcnt pf Revenue
Bca Rcynn-Hickcy Director
City Hall, Room I07A 121 North LaSalle Street Chicago. llliiMH 60602-1288 (.112) 747.4747 (IRIS) (.112) 744-0471 (F AX) (3121 744-2975 (TTY)
FLORENTINO GARCIA 3314 W PIERCE AVE CHICAGO, IL 60651
Dear Applicant:
The Department of Revenue received your request for disabled parking signs. The application was reviewed and a survey of the location was conducted. The Department cannot recommend the application.
The Department's reason for not recommending the application is:
Reason Not-Recommended: ALTERNATIVE ACCESSIBLE PARKING Explanation: GARAGE AT LOCATION
Appeals must be filed within ten (10) days. Appeal requests must be made in writing and state reasons to support a request for a review. Appeals may be directed to the Mayor's Office for People with Disabilities (MOPD), Disabled Parking Signs Appeal, City Hall, Room 104, 121 N. LaSalle St., Chicago, iL 60602. A decision regarding an appeal will be made within thirty (30) days of the request. Applicants are notified by mail of the final decision.
Should you have any questions or require additional information, please contact us at (312) 742-7434.
Very truly yours,
Anthony Gambino Manager of Parking
December 29, 2010
To whom it may concern:
We. A\da and Virginio Gonzalez are the owners of property: 3314 .W Pierce Ave, Chicago, IL 60651. We are requesting handicap parking signs and/or poles be installed in front of our building for a tenant who lives in the second floor of our building. Our tenant, Florentine Garcia is handicap and it makes it difficult for him to get from the building to his car and vice versa. The garage is unavailable as it's already occupied with other tenants from our building. Please feel free to contact us with any questions or concerns.
Thank you.
Aida and Virginio Gonzalez 3314 W. Pierce Ave Chicago, IL 60651 773-387-7576