CITY OF CHICAGO BACP-PWU GRANT OF PRIVILEGE PERMIT APPLICATION V.05.27.10
APPLICANT INFORMATION ^ .
LEGAL NAME OF ENTITY: Y\ lvfr/~i / &&A\ i -*S\~
PERMIT MAILING ADDRESS: W <S «T</ Li) . QoYta/Vy /\
CITY: f>L 0tf.A^7 JTACT
STATE:
ZIP:
CONTACT PERSON:
___■ $A<^~*_TITLE: _
PHONErrre yya.<<fr-7 FAX:7Ta mo E-MAIL: fc>£&<IU.^rq>ft<j.
PROPERTY OWNER INFORMATION
NAME: ^ v'^W £s> drt I (. ADDRESS: <l U> . CuflcvK Ad .PT
CITY:
STATE:
ZIP: G>QtoH\
USE OF THE PUBLIC WAY
1. List the proposed or existing use(s) below, and complete the worksheet on page 3. Use only one application for all public way use type.
TYPE
HOW MANY? BUILDING ADDRESS
±R?*\ \Ai. C uLL/> fA -for*.
2. Please enclose one sketch of proposed use of the public way, which maps to scale the proposed use and its relationship to surrounding right-of-way. All measurements must be indicated.
3. All "No Fee" items require a $50 application fee. Please remit with application.
4. "No Fee" items are listed in the price list on page 6.
5. 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 mags as part of the application, and the attachments herein, are true to th
F.E.I.N. or SOCIAL SECURITY NUMBER:
Si- *-LW "?£({
ALDERMAN'S APPROVAL
As part of this application process you are requirartto notijj^obtain approval from the Alderman in whose ward your proposed*«Se"'q^hei£ufc1ic vya/is I
C H I C A
m
BUSINESS AFFAIRS &
a| City of Chicago | Department of Business Affairs and Consumer Protection | Public Way Use Unit j* Business Assistance Center | City Hall, Room 800 | 121 North LaSalle Street | Chicago, Illinois 60 zoNsminmtiiON www.cityofchicago.org/bacp | 312.74.GOBIZ (744.6249) | 312.742.1974 (TTY)
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