APPLICATION TO USE THE PUBLIC RIGHT OF WAY
APPLICANT £j>7%frO0
LEGAL NAME OF ENTITY: Afiffr&l ■ &0 0 J^*^.
PERMIT MAILING ADDRESS:
CITY 0\\\ CCxJXp>_STATE \ L. ZIP CODE: (pCjb2&
Please submit all of your application materials via mall to the following address. No toes will be accepted.
City of Chicago Department of Business Affairs and Consumer Protection Public Way Use Unit Customer Service Center 333 & State Street, Suite LL30 Chicago, IL 60604-3977
(3I2J74-G0B1Z (744-6249) (312)742-1974(TTY)
CONTACT PERSON: K^Vxlnnl RgJ&ufl TITLE f\l\M IT_
PHONE.:TCg-2'75'-jg5fi^FAX:_ EMATI.: fYlS \:(\\]\\f]rV^i)Q\jfl W) (hr)
USE OF THE PUBLIC WAY
1. List the proposed or existing use below and complete the attached worksheet. Only use one application per public way use type.
Type
fMrit Siqn~
How many?
_Building Address
V52.V ttilasw'i- nfral
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-cffeway. 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, and true to the best of knowledge and belief.
By:
Title:
F.E.5.N. or Social Security Number: ]2 7 -2. (& / 1 9 7 /______■ ■ i. ■
ALIJERMAi <'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.