APPLICATION TO USE THE PUBLIC RIGHT OF WAY
APPLICANT INFORMATION ; . - .
LEGAL NAME OF ENTITY:_tAflJrtGi, V^-YY^W^X^__
PERMIT MAILING ADDRESS: 7Jl^lj\ (U . CtU \jUr~hSY)
CITY: °nCt_-> STATE: X( ' k ZIP: UoGgO X
CONTACT PERSON\ U\fU/\G^ Kfl ml ter^-TITLE:
PHONE: 7n3-yil^%2-Ov^ FAX: E-MAIL:
PROPERTY OWNER INFORMATION
NAME:_MlXrifl^ ^^1/^ _
ADDRESS: I yffi (P. ^ffl ^ -
CITY: r)f\Oj^> STATE: J-U- ZIP: IgQUX^S
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 4.
5. The prints should also accurately depict the location of the property line and public facilities (meters, light poles, sidewalks).
APPLICANT CERTIFICATION
-4£_ 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:^%^^ f)U^/ _;__TITLE: DlUnV^
F.E.I.N. or SOCIAL SECURITY NUMBffi: a.'n-M 3 - «f.3f5~jf
ALDERMAN'S APPROVAL
As part of this application processfyoulare required to notify/obtain approval from the Alderman in whose ward your proposed/Jse of thre public way is located.
ALDERMAN'S' SIGNATURE
DATE:_//1/6/(0___WARD: or
CHIC A GO_______
I'»*IK»P? City of CMcaS° I Department of Business Affairs and Consumer Protection | Public Way Use Unit
Business Assistance Center | City Hall, Room 800 | 121 North LaSalle Street | Chicago, Illinois 60602
312.742.1974 (TTY)