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City of Chicago
Department of Business Affairs and Consumer Protection
Business Assistance Center - Public Way Use Unit City Hall -121 N. LaSalle Street, Room 800 Chicago, IL 60602
09/27/2010
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355
Shirley Petracek
Douglas Park Church Of The Brethern 1605 S. California Blvd. Chicago, IL 60608-1795
SECOND NOTICE
Dear Shirley Petracek:
Enclosed is the annual bill to authorize public way use for the following:
Account: 346158
Site: 1
Location: 2751 W. 16TH ST.
Permit Description: Fence
Permit Number: 1088370
Permit Term: 10/07/2010 -10/06/2011 Year(s)
Default in permit payment terms will terminate your permit privileges granted by the Chicago Department of Business Affairs and Consumer Protection.
Please follow the simple steps below to ensure you are in good standing and legally using the public way:
1. Submit $400.00. Return the payment with the coupon in the envelope provided to ensure your payment Is appropriately credited to your account.
2. Avoid a hold placement on your account by paying the permit fees within 30 days.
3. Please submit an updated certificate of Insurance naming the City of Chicago as additional insured.
4. Direct any questions to (312)-74-GOBIZ (312-744-6249).
A 25% penalty will be added for payments received after due date.
CHICAGO DEPARTMENT OF BUSINESS AFFAIRS AND CONSUMER PROTECTION If payment has already been submitted, please disregard this notice.
12/06/2010 15:51
3096474828
CANTON COB
City of Chicago
Department of Business Affairs and Consumer Protection
Business Assistance Center - Public Way Use Unit City Hall -121 N. LaSalle Street. Room 800 Chicago, IL 60602
PAGE 10
Page 2 of 2
09/27/2010
Douglas Park Church Of The Brethern 1605 S. California Blvd. Chicago, IL 60608-1795
NOTE: HOLDS CURRENTLY EXIST ON YOUR ACCOUNT. PLEASE CONTACT CUSTOMER SERVICE IMMEDIATELY AT (312>-74-GOBIZ (312-744-6249) TO RESOLVE.
1. Please return your payment in the enclosed envelope with the coupon at the bottom of the page to ensure your account is appropriately credited for your payment.
2. The City of Chicago accepts the following payment methods: Personal Check, Money Order, Cashiers Check, Visa, Mastercard, Discover, American Express and Diner's Club/Carte Blanche (Fill in account number, expiration date, and sign return portion below). Please do not send cash paymentsThrbugh the mail. ~
3. If you have experienced an NSF (Non-Sufficient Funds) hold, you must pay by Cash, Cashier's Check, or Certified Check.
4. Please realize that interest, penalties and late charges may apply to your payment. The amount quoted in our correspondence is the amount due on the date of this notice.
5. Delinquent and/or Deficient payments will result in a hold being placed on your account. A hold will prohibit the renewal or issuance of any License(s) and/or Permit(s).
6. Make check(s) payable to the City of Chicago, Department of Revenue. Include your account number on your check/money order. Checks must be preprinted with name and address. Second party checks will not be accepted.
7. Cash and other payments may be made in person at City Hall -121 N. LaSalle Street, Room 800.
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Detach and return bottom portion with your payment
Account* |
sue , |
, pharge Type |
: Permit Cade Description * |
Permit Number |
Period |
Due Date |
. Amount Due |
346158 |
1 |
PERMIT ANNUAL BILLING |
FENCGATE - Fence |
1088370 |
10/07/2010-10/06/2011 |
10/30/2010 |
$400.00 |
Please contact customer service at
(312)-74-GOBIZ (312-744-6249) for address changes
1 0006791106 0000346158 0001 0000040000 101 0000 0000
City of Chicago
Department of Business Affairs and Consumer Protection Business Assistance Center - Public Way Use Unit City Hall -121 N. LaSalle Street, Room 800 Chicago, IL 60602
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|~] Visa Q Master Q Discover fj Diners fj American Card Club Express
Credit Card Account Number
Expiration Date (MM/OO/YYYY)
Amount Enclosed
Signature Dale I agree to pay tha abova total amount according to card Issuer agreement (merchant agreement It credit voucher).
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Please attach your Certificate of Insurance to this form
PUBLIC WAY USE UNIT: PERMIT INDEX COVER SHEET
DBA Name Location Account Number Site Number Area
Permit Type Permit Number
Douglas Park Church Of The Brerhern
2751 W. 16THST.
346158
PERMIT
-PENCCATE
1088370
For Office Use Only
Document Type FOR Imaging
(please circle one)
Permit Application (approved only)
Plans (approved only)
Pictures (approved only)
Acceptance Letter (approved only)
Insurance Certificates (approved only)
Miscellaneous Documents
(originally submitted/incomplete applications, plans, photos, insurance certificates, etc.; Customer Service Center and PWU deficiency notices, fee calculations, etc.)
Affidavit
Permit Correspondence
(pending passage letters, direct introduction requests, etc.)
Doc. Category
APP
PLAN
PIC
ACCLTR
CERT
MISC
AFF COR
Exemption Documents Contracts
Journal of proceedings
Hearing request
Order of Findings (DOAH)
JRNL FBAHN
Doc. Type
APP
PLAN
PIC
LTR
CERT
MISC
AFF PERMIT
COR EXEMPT CNTRCT CNTRCT
JRNL HRNO
FBAFOD FBAFOD
Total Number of Pages:
(including index cover sheet)
Revised