FROM ALDERMAN ED SMITH
(WED)JAN 26 2011 11:48/ST. 11:20/No. 6835156618 P 14
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APPLICATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
78097
An application will no) De considered complete unless All lines ol the application have been completed in lull:
• A check or money order lor 570.00 made payable to the City ol Chicago is submitted as payment ol me application Ik>>. Please note: The application lee snail be waived lor any person holding a valid current disabled veterans plate
• Disability must be permanent as evideiKed by a copy ol your valid disabled placard and/oi current vehicle rcg'sKit'on submitted at the time of application:
• Proof ol residency, in the lorm ot a copy ol your drivers license, state identification, or utility bills are submitted ,i; tiio time ot application
Completed application forms may be returned to: the office ol your alderman, any Oiy of Chicago Department ot Revenue faciiily, or via mail at P.O. Box 803100 Chicago. IL 60680-3100, ATTN: Disabled Permitting Section. A $25 00 m.nnton.wr tee will be billed lo you annually. Should you have questions or concerns, please call our permit processing divisic- i: :3° r 744-PARK (7275) '
; 1. Oaie of Birth
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7. Slate Idrintilicatiun Numboi
3. Drivers License Number
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i 4. Applicant Last Namo
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5. Home AOOress (primary ros'Ooncet
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6 AdO'ess where signs will tm pusicu
7. Phone Numbers Home ! 8 Current Permanent Disabled Placard Numbor
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j 0 Current LiCOOSO PlilM Numho'
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10 Description ol Medical Conation and Disability
Alternative Partung; Ploaso note your application may bn denied if you have alternative accotsit'lo oll-slteo! p.vkinrj options
11 is there of<-slreel parking available at your primary residence J VES $fNO li e. garage, car dot driveway, etc.)?
1? II vou answered Ves to question 1I. plbSiw ciui/dbo J Garage: J Onveway: J Car Pon: J Othor
13, la youi oll sireoi parking accessible'' □ Yes: 3 No Please enplain
U. Attirmalion: I hereby affirm that the above inlormanon is true and correct II the Ory ol Chicago Ocpanmcnl ol OovcndC oeKirmi^n'.
thai Ihe applicant has lalsely represented one or moio ol too aDovc condition), ihe applicant snail be swbiect to a imc of nm >cs* iimk SI00 bet no more than 5500. and the application shall oe den'Ofl i also understand that ii is my responsibility to noti'v th? Owt.-in"-: •>• Aevenue ol any changes in thejnlpuxiajipn presided.
Signature
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^f^LACARD/PLATE ^I^ES
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FOR OFFICE US^MLY
RESIDENCY
FROM ALDERMAN ED SMI
TH
(WED)JAN 26 2011 11:48/ST. 11:20/No. 6835156618 P 13
City of Chicago Richard M. Daley, Mayor
Department of Revenue
Bca RcyrM-Hickey Director
City Hall. Room 107A 121 North U&llc Street Chicago, Illinois 60602- 12X8 (312) 747-4747 (IRIS) (3)2) 744-0471 (FAX) (312) 744-2975 (TTY)
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December 8. 2010
LUIS A PACHECO 3523 W WALNUT ST CHICAGO. IL 60624
Dear Applicant:
The Department of Revenue has recommended installation of disabled parking signs 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 pioposed 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 lo 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 licensa plate, pemianpnt parking placard or rlovice 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 dovices issued to you by the State of Illinois:
* You must continue to reside at the homo address listed on the original application.
A residential disabled parking permit will be issued lo you by the Cily 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. Tho permit will be installed at:
Address/Location of Signs: 3523 W WALNUT ST Permit number: 78097
Should you have any questions or require additional information, please contact the City of Chicago's Helpline at 312.742.7434.
Very truly yours,
Anthon/Gambino Manager of Parking
Copy: ALDERMAN SMITH
FROM ALDERMAN ED SMI
TH
(WED)JAN 26 2011 11 :48/ST. 11:20/No. 6835156618 P 11
City of Chicago Richard M. Daley, Mayor
Department wl Rcvvniiv
Itea Reyna-Hickcy Director
City Hall, Rood I07A )2l North USatlcSirtci Chicago, Illinois 60602-128S (312) 747-4747 (IRIS) (312) 744-0471 (KAX) (JI2) 744-2975 (ITY)
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December 8. 2010
ALDERMAN ED SMITH WARD 28
259 N PULASKI RD. CHICAGO, IL 60624
Dear ALDERMAN SMITH:
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 an ordinance to post residential disabled parking signs at the location recommended, if one has not yet been introduced
Applicant's Name: LUIS A PACHECO
Applicant's Address: 3523 W WALNUT ST
Address/Location of Signs. 3523 W WALNUT ST
Permit Number: 78097
Work Order Number: H10-1411
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,
Anthorry Gambino Manager of Parking
Enclosure: Disabled Signs Application