HomeMy WebLinkAboutTemporary Reserved Handicapped Parking Space Sign Permit #11316 COUNTY -CITY BUILDING
227 W. JEFFERSON BOULEVARD
SOUTH BEND, INDIANA 46601-1830
PHONE 574/235-9251
FAx 574/235-9171
CITY OF SOUTH BEND JAMES MUELLER, MAYOR
BOARD OF PUBLIC WORKS
October 10, 2023
Ms. Helen Wituski
3427 St. Johns Way
South Bend, IN 46628
hwituskigsi cindiana. com
RE: Reserved Handicap Parking Permit
East Side of Lafayette Blvd., North of Jefferson Blvd. #1
Dear Ms. Wituski:
At its October 10, 2023 meeting, the Board of Public Works approved your request for
a Paid Reserved Handicap Parking Permit. The location will be the East Side of Lafayette
Blvd., North of Jefferson Blvd. #1.
Enclosed is the permit authorizing you to park your vehicle, 2012 Chew, Captiva, in
the corresponding parking space on East Side of Lafayette Blvd., North of Jefferson Blvd. #1.
Please be advised that you must display the reserved handicap parking permit on your
dashboard at all times when you are parked in the corresponding reserved handicap parking
space. Also, please note that this space is reserved as a handicap parking space only between
the hours of 7:00 a.m. to 5:00 p.m., Monday through Friday.
The fee for the Reserved Handicap Parking Permit will be Forty -Five Dollars ($45.00)
per month, due by the first of every month, and made payable to the City of South Bend. A
yearly renewal of this application is required.
If you have any further questions, please call this office at (574) 235-9251.
Sincerely,
/s/ Theresa Heffner
Theresa Heffiier, Clerk
Enclosures
TH/lh
ELIZABETH A. MARADIK JOSEPH R. MOLNAR GARY A. GILOT ALEXANDRA DOLZ-LANE MURRAY L. MILLER
Tyr$ . RESERVED COUNTY -CITY BUILDING HANDICAP PARKING
PERMIT APPLICATION AND AGREEMENT
City of South Bend - Board of Public Works
k
227 W. Jefferson Boulevard, Ste. 1316
South Bend, IN 46601
Applicant Information 1,
First Name. / e-) Y) Last Name �n S% t
Date of Birth'- a %' �� q Last Four Digits of SS# _531,1 1
Driver's License No.
Address 2 Y7 P/ S ` n.s
Street
Phone
Vehicle Information
X
City State Zip
Email h w ' >1-u3X /' 537T<�_ IIA,4 yrX , Cngt
Male
_(7/_he_v�l Model �' -64(' % /V-,,4 Year
Handicap Permit No.2License Plate No.
Employer Information
Name of Employer v s
Supervisor Nam ' 7
Address r�
WLocation o ntrance W_ to Bu dg�ing
Daily Work Schedule
Days: TzA-- _7
Hours S ,_/3D10M
No. of Hours Per Week Y
Doctor's Note Included
Yes V No
'5)�Y)V_j
FullTime? Yes ANo
Where do other employees park?
What efforts were made to apply for applicant's parking needs?
ig
i Qit )A__9D x/
Typed or Written Name
AGREEMENT
/�
Date
I, / )14 S , hereby attest and affirm that the above information is correct to
th6 best of my knowledge. I also agree to pay the City of South Bend forty-five dollars
($45.00) per month on the first Monday of each month, during which time I am authorized to
utilize the reserved parking area as approved by the Board of Public Works. A yearly renewal
of this application is required.
pplicant Signature Date
Typed orWritten Name
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
Elizabeth A. Maradik, President
Gary A. Gilot, Member
po,�, .4 ,yam,
Murray L. Miller, Member
Joseph R. Molnar, Vice President
UkLv� 64�
Alexandra Dolz-Lane, Member
Attest: Theresa M. Heffner, Clerk
Date: October 10, 2023