CITY OF CHICAGO BACP-PWU ■ BUNDLE PERMIT APPLICATION ■ V.'04.28.10
APPLICATION TO USE THE PUBLIC RIGHT OF WAY
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| DOB PERMIT tt: |
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| AMNESTY ELIGIBLE? |
□ YES |
□,NO" |
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APPLICANT INFORMA TION
LEGAL NAME OF ENTITY PERMIT MAILING ADDRESS CITY: ri^CQCVO
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SS: \ Wt> ^- \t\no,cbuvrM ." Su^fc rV> 1
STATE: -JH.^ '
CONTACT PERSON: 6M T^Qr^hoC
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ZIP CODE:
TITLE:
PH0NE:^|2_^-r.2-'2OO FAX: - gy? C"5 go E-MAILfy47p^ ft PprnQDav-Wlen^S. C c5V^
BUILDING OWNER INFORMATION
name: Lincoln rVpptr\rnenT\ ^/vii-tfA PQ^h-Vf-^ip_
ADDRESS: rftnflshnru .<
CITY: CKICcOQo ^STATE: '^tT_, . ^_
PHONE:-313-22oO FAX: ^-^-g^Q. E-MAIL: ^fo ^ p» ^J^,,^ ^
ZIP CODE: faoo^a>
* (Zip
L/SE OF 77/E PUBLIC WAY
1. List the proposed or existing use below and complete the worksheet on page 3. Use only one application for all public way use type.
HOW MANY?
BUILDING ADDRESS
2. Please enclose one sketch of each proposed use of the public way, which maps to scale the proposed use(s) and its relationship to surrounding right-of-way. All measurements must be indicated.
The prints should also accurately depict the location of the property line and public facilities (meters, light poles, sidewalks).
APPLICANT CERTIFICATION
I hereby certify that all statements made as part of the application, and the attachments herein, are true to the best of my knowledge and belief,
BY: O-v chCvWbGo ( do- Q
F.E.I.N or SOCIAL SECURITY NUMBER:
)
TITLE:
ALDERMAN'S APPROVAL
As part of this application process, you "ire required to notify/obtain approval from the Alderman in whose ward your proposed use of the pjjblic way isjesated.
DATE: CpDy-^
Department of Business Affairs and Consumer Protection Business Assistance Center Public Way Use Unit ■ City Kail, Room 800 121 North LaSalle Street, Chicago, Illinois 60602 KSSw www.cityofchicago.org/city/en/depts/bacp' 312.74.G0BIZ (744.6249) ■ 312.742.1974 (TTY)
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