Office of the City Clerk - Record #: O2011-1501

• Record #: O2011-1501
• Type: Ordinance
• Status: Passed
• Intro date: 3/9/2011
• Current Controlling Legislative Body: Committee on Traffic Control and Safety
• Final action: 4/13/2011
• Title: Handicapped Parking Permit No. 69164
• Sponsors: Hairston, Leslie A.
• Topic: PARKING - Handicapped
• Related files: SO2011-3566

Date	Journal Page Number	Action By	Action	Result
4/13/2011	115430	City Council	Passed	Pass
4/6/2011		Committee on Traffic Control and Safety	Recommended to Pass	Pass
3/9/2011	114170	City Council	Referred

02/18/2811    38:27 7733241585

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APPLICATION FOR DISABLED PARKING SIGNS 59 ■, 64

PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM

An application win not he considered complete unless:

• Ail lines o* the application have been completed in full.

A check or money order for S70.00 made payable to the City ot Chicago is subnM:*ci at. r.nvn«*»M    t'v aapiurf- ■ Please note: The application lee shall be waived lorany oerson holding a valid, cir^nt rii*<it;*t<i «••!««»■« pint"

• Disability must De oernanem as evidenced by a cony erf your valid diMfolec piaCiuo r'i>:.i ■>    ■<;-•>     -;ic- ,{,.,;.,-•• ,i- .-. submittec! at the time ol application;

Proof of residency, in Ihe 'cm ol a copy of your arivers license, slate icientih-^iMn :v mhIi; . utowiifc.: .1 i

time o< application

Completed application lorn-is may be returned to: the oflice of your alderman, any City ot CluAutic i. 'i; .i- :i:-:m ._:>- ■ >(.'■,■<.■: . ,. facility. r>r via mail at P.O. Box 803100. Chicago. IL 60680-3100. ATTN; Disabled Pem-iittinn Section A S2S.00 •n^nnyviro fee will be billed to vou annually. Should you have questions or concerns pieasr can aw pww.f. ■r-Kwt'yq ^H.iv.sr■•: 744-PARK (7275I.

■ 1   Dale otolith ' 2   State Identification Nijmber I :i.   0".''-. '. i::'r.s!- Ni

WO       _        i'A' _ 'I.M. _ _ _

⁰ i 3 i.....L_L2_i X]£jA.J.rLtf±/j./ lALiM.M.fejj:.J.:^,r.cv , / u /"V.

*. Applicant Last Name T mi "

..... k:<> io Ia/:....:.................j......,....|£

5. Home Address (pnma<y residence)

STHFI-1 Sin*fO        1 run |  jtiu.[t s,»vl

4?!7i/ IV j   S    i/?i*ift,f g;/,E.  73:1-' if A . . j £ . ,_{; (}.

Fir?! Maine

6 Address where signs will be posted

ll ill^£^l€l 1 71/ l^uAhm^lIl....I........I. k:. f i-, /

i 7. Phone Numbers Homp ; Business

L.7.iljlZA....A All. .7.1? "J i

j 8  Currenl Permanenl D'Sabted Placard Number        ¹ Registered if

¹        /6⁽7i~;? '7Z±k$o<-^;

'■.i: : ■ ,1:

SV Current License PlaiO Numfioi Registered to    i   Cily S;n:kr.' Mr. <^:'. <i

\.Hl-^ci+-369______......... f-ftZ&c* ..............;.

^: "0 DrsciCtion ol Mndnial ConrJiimn ant; Dir-ari'lity fiLlL-C   Tif^/tS if"'    ' X *t-~-   ■'i   f <-'■

! Alternative Parking¹ otoase noi': yc-in iionlication outy l>« denwj it yd' h\t»vt- ai|r>rii»!--ve .v.ee«si(M.- •

■ '! In t'asMV off-street paring available ai your primary reS'Ctenec YER    -J NO I     (i.e. garage. rn no't. ativcwjjv nit: P

■ " '!y^ou t'n?were0 Vc;. ro auifsfiun 11. please deseriSe ^jGar^e:     JPnvpwav:       J Car Port J Oilier.

: 13   yoirr oli-strccLp^rking accossibte⁷ AStff&KdisJ (asAc-K wily   ~/~7;  _i-.'-^'r-.W ■•v"'

■r.i )■> -!M : :i' ir.>»

14. AKirmsHon: l hereby ttlfirm thai the above information is. true and corroci. 11 iho Dtv o! Cr^i w.\   _;1 >."i;n:v--.i ! i....

•hat the applicant has 'aisely represented one or mo'o of Ihe above conditions, the applicant sh.ill Vie. r*ul>|i,-r;: u, imr r- r,c.: if.r.«. f 00 but no more than $000. and ihe application shall be denied. 1 also understand thai it *     ritsoonsiWitv 1 r«Mi!>. :: Onsa'in---Revenue o' any changes in the information provided *

Signature

FOR OFFICE USB^QNLY V, Q>\.^Ct' &  '( ' > X

JTFEE J PLACARD/PLATE     ^.RESIDENCV        J COMPLETE     ^-7/ ,