CITY OF CHICAGO • BACP-PWU • GRANT OF PRIVILEGE PERMIT APPLICATION • V.05.27.10
APPLICANT INFORMATION
LEGAL NAME OF ENTITY: 3^k> X~la "fS, Jw> jCjfcV\_
PERMIT MAILING ADDRESS: ^(**=rf KJ . VXAaj* . CITY: f WZ Uy-^K-n STATE: JL ¦> ZIP: foQ^fo O
CONTACT PERSONr* JVa £,TITLE: p ^ft g r_
PHONE^ll^ FAX: iojft E-MAIL: V^UyN^yn^^WA-^l*Yl
PROPERTY OWNER INFORMATION
NAME: _Ly> t»V\ VCt/n _
ADDRESS: A/ ¦ <<^*Ltf Avf.
CITY: ^A/z^ajs STATE: J^L- ZIP: fcOlkn
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______
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 made as part of the application, and the attachments herein, are true to the best of my knowledge and belief.
BY: ^^M^Jkcjif)_ TITLE: Dldflje C__
F.E.I.N. or SOCIAL SECURITY NUMBER: -ej^-l^i^^_
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 located.
A%-
ALDERMAN'S SIGNATURE: DATE: Ol-Jl6!. ipIO
WARD:
CHICAGO
sijgfratssswra City of Chicago | Department of Business Affairs and Consumer Protection | Public Way Use Unit BJs7iisfvF?AjRs> Business Assistance Center | City Hall, Room 800 I 121 North LaSalle Street I Chicago, Illinois 60602 consume*protection www.cityofchicago.org/bacp
| 312.74.GOBIZ (744.6249) | 312.742.1...
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