* Application to use the public right of way
APPLICANT INFORMATION
LEGAL NAME OF ENTITY: rV.^hOQ VmA 1 AJ
PERMIT MAILING ADDRESS: |C,7J Soofr> t\-<\* r~
CITY: CV\*yo_STATE: ttL_ZIP CODE: IgOtufi_
CONTACT PERSON. C U-A lu^_TITLE: ^c-Wj JUUmy^
PHONE: -3««,Z.7--£MO FAX: ICt-'^Zl ~-L1a\_E-MAIL: <OW<>fl d^nhf r«p . r*<A
USE OFTHE PUBLIC WAY
1. List the proposed or existing use below, and complete the worksheet on page 3. Use only one application per public way use type.
TYPE HOW MANY? BUILDING ADDRESS
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.
The prints should also accurately depict the location of the property line and public facilities (meters, light poles, sidewalks).
APPLICANT CERTIFICATION
I hereby certif are true
BY:
all statements made as part of the application, and the attachments herein, t of my^rrowledge and belief.
TITLE:
F.E.I.N, or SOCIAL SECURITY NUMBER: frCrCfl t-
ALDERMAN'S APPROVAL
As part of this application process, you are required lo notify/obtain approval from the Alderman in whose ward your proposed use of the public way is located.
WARD
ALDERMAN'S SIGNATURE
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CHICAGO
City of Chicago | Department of Business Affairs and Consumer Protection | Public Way Use Unit business affairs a Business Assistance Center | City Hall, Room 800 | 121 North LaSalle Street | Chicago, Illinois 60602 zonsumirnoncvoN www.cityofchicago.org/bacp | 312.74.GOBIZ (744.6249) | 312.742.1974 (TTY)