01/25/2011 11:19 FAX 773 261 8687
29TH BARD ALO GRAHAM
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AFPUCATION TO USE THE PUBLIC RIGHT OF WAY
APPLICANT INFORMATION:
NAME; Jig Metal Products Co
ACCTfc
4516
RENEWAL
SITE*; ]
PERMIT*;
104*902
ADDRESS:
5841 W. Dickens Ave.
ZIP CODE;
60639
CONTACT PERSON: Jay Obcmedcr
phone; <fiaaimjes9
TITLE:
I I Check box for change of mailing address. Provide information below New Mailing Address:_____
Phone: ._,_______
Contact: ____' __._
Note: Any changes to ownership requires a new application.
ir no changes, complete applicant certiflcadon, obtain Alderman's signature, include photo(s) and sketch a* described below. Return to:
City of Chicago
Department of Business Affairs and Consumer Protection Business Assistance Center - Public Way Use Unit Chy Hall -121N. LaSaUe Street. Room 800 Chicago, IL 60602 (3I2KT4-GORIZ (312-744-6249)
USE OF THE PUBLIC WAY
Type_ How Many? Building Address
I Manhole I 1 I 5841W. DICKENS AVE.
ALDERMAN'S SIGNATURE: Z_WARD;_29 DATE; 1/24/2011
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