CITY OF CHICAGO ■ BACP-PWU BUNDLE PERMIT APPLICATION Vl.04.28.10
APPLICATION TO USE THE PUBLIC RIGHT OF WAY
| ■ L OFFICE USE ONLY |
| DOB PERMIT *: |
|
| AMNESTY ELIGIBLE? |
□ YES |
□ NO |
|
|
|
APPLICANT INFORM A TION
LEGAL NAME OF ENTITY: S"u J ^ Q~&JrL. gXdTft-K- SoIa^^ <L
PERMIT MAILING ADDRESS: M>ib L., J&Z_u, ,Jc P/xO~t>< f^^zJi
CITY: CA,.^^> STATE / ZIP CODE: Y^ V if f
CONTACT PERSON: " g/ct V^ao-U.^ TITLE: ^ ~ '
PHONEr?-?^ g^yiy?] FAX: -7 -ix-Cr&f *-fK>~7~\ E-MAIL: Z>ort^k frZl&/hSUd
BUILDING OWNER INFORMATION
NAME: S <-(^ ~QZ> IM PriL* j~7 *J uC*C~-i___
ADDRESS: *j X (_ ^/Lj/f/UQ P/yt2-*f /Zo
CITY: P,fo,c &rf(> STATE:_U-_ZIP CODE:/^^^ <l, /
PHONE:-773 ^^^.OCFAX: 79^^Fr^67^- E-MAIL:
L/S£ OF THE 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.
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 ofthe application, and the attachments herein, are true to thgjbasjt of my knowledge and belief.
TITLE: y&£<0~ri£*-
SECURITY NUMBER: T.£0-Z*t.-0f<rZZ,
ALDERMAN'S APPROVAL
As part of this application process, you are required to notify/obtain approval from the Alderman in whose ward your proposed use of the public way is located.
ALDERMAN'S SIGNATURE:
DATE: ficJob-tr 13 I^jID // ^^fcC^.i 3g
CHICAGO
IMM^ Department of Business Affairs and Consumer Protection Business Assistance Center lM&W%?§s% Public Way Use Unit City Hall, Room 800 121 North LaSalle.Street, Chicago, Illinois 60602 cowu«!» p/otV"on www.cityofchicago.org/city/en/depts/bacp- 312.74.G0BI2 (744.6249) 312,742.1974 (TTY)