Ordinance O2011-548
Passed
Handicapped Parking Permit No. 77477
Sponsors
| Sponsor | Ward | |
|---|---|---|
|
Harris, Michelle A.Primary Sponsor | Ward 8 |
History
Legislation Text
MEMORANDUM FOR TRAFFIC REGULATIONS
OVERRIDE
PROHIBITION AGAINST PARKING (Except for the Handicapped):
Street, etc:
South Harper Avenue
Location, etc:.
No. 8007
(Permit No. 77477)
Distance or extent:
Hours:
at all times
Days:
no exceptions
ADA L. BALLENTINE
MICHELLE A. HARRIS Alderman, 8th Ward
01/05/2011 WED 15:07 FAX
0001/00
4
APPLICATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
77477
An application will not be considered complete unless:
• Ail lines of the application have been completed in full;
• A check or money order for $70.00 made payable to the City of Chicago is submitted as payment ol the application fee: 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 form of a copy of your drivers license, state identification, or utility bills are submitted ai 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
MO _ DAY
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2. Slate Identrfication Number I
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3. Drivers License Number
4. Applicant Last Name
"b\A\L\L \ew\r
Ml j First Name
5. Home Address (primary residence)
STREET NUMBER
H\o\o\l\
SrRfcErNAMfc
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6. Address where signs will be posted
STREET NUMBER «R. STREET NAME
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7. Phone Numbers
Home
n\n 13 l a la l / l n\ v
8. Current Permanent Disabled Placard Number
3ft )%HM
9. Current License Plate Number
JL
!6
LL
W'.\fV, :..;VK!'J:
Business
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Registered to
Relationship to Applicant
Registered to
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City Sticker No.
Relationship to Applicant
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10. Description ol Medical Condition and Disability
Altemative Parking: Please note your application may be denied it you have alternative accessible otl-street parking options.
11. Is there off-street parking available at your primary residence 3 YES (i.e., garage, car port, driveway, etc.)?_
I NO
12 If you answered Ves to question 11, please describe: 23 Garage: □Driveway: -J Car Port; □ Other:
13. Is your off-street parking accessible? /.. iaaju H\ ■fJ-if>nC £^ruiJ tjUCci^ -Utt tA
SI Yes; 4^No. Please explain: ^ U f 5
14. AHirmation: I hereby affirm thai the above information is true and correct. If the City of Chicago Department ol Revenue determines that the applicant has falsely represented one or more of the above conditions, the applicant shall be subject to a fine ol not loss than $100 but no more than $500, and the application shall be denied. I also understand that il is my responsibility to notify the Deparimeni of Revenue of any changes in the information provided.
Signatun
Dale S£
J COMPLETE ^(XjC^
FOR OFFICE USXQNLY
/fFEE
PLACARD/PLATE
RESIDENCY