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APPLICATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
An appficallon not be cor^lderad. ,,. !'■;;
All lines of the application have been completed in full;
■ : A check or, ;mohey order forS7p.00 ;mad9 pa>^We; to the Gity ot Chicago issuomitted a> payment pt. the; application lee;
"' .PleasehotaiTho applied ; .- Disability must be permanent as evidenced by -a copy of yoocyaiiiddisabled, ptaea^anc^rcu'rrenl Vehicle;registration
■; submitted at the lima or application; - . ' ■'■ '.■!;: '
> Proof of residency, in the lorm of a cop/ of your drivers license, stale jdentificatiph; ;cir: iuiitUy:.b|ll5 are submitted atthe
.' time of application. ' \ ' i'-j":' i!,!"!'' ' | '. . '
' Completed application forms may be returned to: the'office of your'aldoirnan, any City of'Chicago Dec*rtmo!nr of; Revenue faalily.br Wama^
fee will be billed to you annually.1 Should ybu have question's or concerns, pfoase call our permit processing division at 312-744-PARK (7275).
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1: Oato 61 Btrth
2. Siato Identification Number -
3. Drivers License Number
1 0
I Ml
11
4. Applicant Last Namo
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first Namo
5 Home Address (primary residence)
6T«EEtM<*MA , |»B. '
BTTCeriwiMe
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6. Addrasa whore signs will bopostod
STREET NUWB5K,
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SmttTHUME
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7. Phono Numbers.
Home
'Business1
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8. Currant Pbrmanont Disabled Placard Number
Registered to
Relationship ic-Applicant
8. Currant L'eorise Plate Number
Rogrstered to
. ijCijr- Stlclibr -Moi. ■: :
Relationship; to Applicant
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Altomauvo Parking: PJeaBenot»ypur,a'ppJtato^ .". (i.o.i oaragB.cnrpori, drr^oway.iolc.)? i ' _'__I ,!_: ,■;■'' ■ ■;"
12. It you onswored <Yos to question 11. please describe: Q Garago: ; □. Driveway; . 2 Car Port OOihdr
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FOR QPFICE;.US&gNLY
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03-03-11;01:29PM;
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City of Chicago Richard M. Daley, Mayor
Department of Revenue
Bcq Reyna-Hickey Director
City Hall, Room 107A 121 North LaSalle Street Chicago, IUinoii 60(02-1288 (312) 747-4747 (IRIS) (312) 744-0471 (FAX) (312) 744-2975 (ITY)
BUILDING CHICAGO TOOEfHEK
February 1,2011
DELORES E BELL 5921 S ADA CHICAGO. IL 60636
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 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 to 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: 5921 S ADA Permit number: 77514
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 THOMPSON
03-03-11;01:29PM;
; 7734343889
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City of Chicago Richard M. Daley, Mayor
Department of Revenue
But Reyna-Hickey Director
City Hall. Room 107A 121 North LaSalle Street Chicago, Illinois 60602-1288 (312) 7474747 (IRIS) (312) 744-0471 (FAX) (312) 744-2975 (TTY)
HUII.DINC CHICAGO TOGBTIIKk
February 1, 2011
ALDERMAN JOANN THOMPSON WARD 16
5335 S WESTERN AVENUE CHICAGO, IL 60609
Dear ALDERMAN THOMPSON:
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: DELORES E BELL
Applicant's Address: 5921 S ADA
Address/Location of Signs: 5921 S ADA
Permit Number: 77514
Work Order Number:
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 Gambino Manager of Parking
Enclosure: Disabled Signs Application