CITY OF CHICAGO BACP-PWU BUNDLE PERMIT APPLICATION V.09.28.10
APPLICATION TO USE THE PUBLIC RIGHT OF WAY
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DOB PERMIT #: |
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AMNESTY ELIGIBLE? |
□ YES |
□ NO |
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APPLICANT INFORMATION
LEGAL NAME OF ENTITY:_/fyQiF7lU/frJ frff $ fo/f^bo &"
PERMIT MAILING ADDRESS: 3120 /vA ^L</o^J ^v^T._ _
CITY: asks?** v STATE: ZIP CODE:
CONTACT PERSON: &M/Lf-1 TITLE: QyJrnrA
PHONE: >-7^ jj. (f 7--<f i o ■> FAX: fr? 3) JLCt 7^~7fo 7*7 E-MAIL: ^go^fCS^-^^WJ.
BUILDING OWNER INFORM A TION
NAME: ^ToSt^ph ft-^A^Po^"^_■ _
ADDRESS: 3 y ? gt /nA 7o A/* /^-W
CITY: g-zO^-^-J STATE: ^gr^ ZIP CODE: 6- 0 CIX
phone: frty tM.f-yiyrJr^xiV e-mail
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___
^Ji^l^__)_ 7')3t) N . tTL- c, ? Oa? /^.y\<~ CcSy^} J"/
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 besLof-jny knowledge and belief.
TITLE:
^7 /3/ r?7i
FJETlsft. af^SOCIAL SECURITY NUMBER: -ET*-
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
ALDERMAN'S SIGNATURE: DATE:
WARD: ,y)
C H I C_ A G O
Department of Business Affairs and Consumer Protection (BACP) ■ Business Assistance Center (BAC) Public Way Use Unit (PWU) City Hall, Room 800 121 North LaSalle Street, Chicago, Illinois 60602