CiTY OF CHICAGO BACP-PWU ■ BUNDLE PERMIT APPLICATION ■ V.09.28.10
APPLICATION TO USE THE PUBLIC RIGHT OF WAY
AMtJES1".' ELIGIBLE*
APPLICANT INFORMA TION
LEGAL NAME OF ENTITY: | R Y t>
PERMIT MAILING ADDRESS:
-i a -i i c n <~ t_
CITY: CMXf.hCrG
STATE: \U
CONTACT PERSON: CH RiSTC Vc\££ 1F>An/i>4
ZIP CODE: 6Q6I8
TITLE#-g>WMg/?
PHONE:^175 -*Kl&l FAX:
-MAIL: CJVRANllA HkrlOfi.Cn
M
BUILDING OWNER INFORMATION
NAME: AD/XM P>/-\NlA,
ADDRESS: gq£2. R|, MILUMUK/T^
CITY: £ Hie A GO
STATE:
PHONE: -"173-227- 5^24 FAX:
ZIP CODE: $0 6//?
E-MAIL: CfrftAMA YAHflO., COM
USE OF THE PUBLIC WA Y
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 of the application, and the attachments herein, are true to the best of my knowledge and belief.
BY: CH ftlSTO Pi-I£ft 33- A: hi t k
F.E.I.N, or SOCIAL SECURITY NUMBER:
TITLE:fc-o VJ fO £g
ALDERMAN'S APPROVAL
As part of this application process, you are required tojnotify/obtain approval from the Alderman in whose ward your proposed use of I
ALDERMAN'S SIGNATURE:
DATE: //,■- q-TZ1
WARD:
gVtf^~D department of Business Affairs and Consumer Protection (BACPi ■ Business Assistance Center (BAC) Pa _j£jz\_jT Public Way Use Unit (PWUi ■ City Hall. Room 800 ■ 121 North LaSalle Street. Chicago. Illinois 60602 o -s-iuM-n."-*-iibi www.citvofchicago.org/bacp- 312.74.G0BI2 (744.62-19) ■ 312.742.1974 (TTYl