10/08/2010 16:66 7732020068 BLYTH&A5S0CIATES PAGE
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CITY OF CHICAGO BACP-PWU - BUNDLE PERMIT APPLICATION* V.09.28.10
APPLICATION TO USE THE PUBLIC RIGHT OF WAY
DOS PERUTT* |
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AMwearr ejc-i-s.E> |
□ YES |
□ NO |
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APPLICANT, INFORMATION
LEGAL NAME OF ENTITY: Blu-f^ flW fts&OC\aT<Z<S_
PERMIT MAILING ADDRESS: ?>&DK N C^Ly\^rva I /?✓ ~ CITY: e^KLactn STATE: j ZIP CODE: &>06S*J-
CONTACTPERSONJ fae.tr J- Hlu 4-h TITLE: .4*+ + *\
PHONE: 7 - O <K£TS FAXP"7 7,3 '3.t>ZL -OO & O E-MAIL: J
BUILDING OWNER INFORMATION
NAME. feltf.^ t~ A*<°c<~rtrs _
ADDRESS: -3 Sfo fa" N. C.r^+rA. \ A"f&
CITY: al(lflflfl STATE: IU ZIP CODE: 6,01*
PHONE: 7 7.3 -AdA.-oaso FAX: 7 7*>-XoZ-O0iJ> E-MAIL: bU/Hi fiiangi/) I
USE OF THE PUBLIC WAY '
1. List the proposed or existing use t<elow 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 lis 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: //? ^?tZ5&_TITLE: ot**j* a_
F.E.I.N, or SOCIAL SECURITY NUMBER;_ 3 t> - *fOS£ 7 7/_
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-p^blic way is located.
ALDERMAN'S SIGNATURE: J&-^C--v^ _
DATE: /L^^ff&M
o_o_,___ . _ _
Department of Business Affairs &nd Consumer Protection (BACP) ■ Business Assistance Center (BAC) _ Public Way Use Unit (PWU) ■ Cily Hall, Room 800 121 North LaSalle Street, Chicago, Illinois 60602
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