REQUESTOR ADDRESS BUSINESS NAME
uc_|ca E-' 5
J4f3^f4- byj. MQ AS,(z PHONE NO. fflh\ ST7 - 3 £o 9
HRS OF OPERATION / Z<Xav
BUSINESS ADDRESS ?4(2-^ &7 , /tco ^Sg_
BUSINESS PHONE (7^>_z2£_Ll22-Z2_ FAX NO
HRS OF OPERATION _ ZIP
EMail address
EXACT ADDRESS OF INSTALL f Z~ H> IV
type of business R-fcS r Amu. «rr
NON FOR PROFIT
YES OR vj^oj) (if yes. attach tax except letter)
CONDITIONS
raiimS**** 60 dayS'if P8*""** not received within that time frame the ordinance will be
Zi , 0r9,na, 0,81 of ^B"8^- you are responsible for yearly mainaintance fee. If you move,
relocate. and/or cnange businesses you must notify the City of Chicago.
SIGNATURE
FOR OFFICAL USE ONLY
c
SIGNAGE
TYPE OF RESTRICTIONS REQUEST
Sl
INSTALL RELOCATE
CHANGING
TRAFFIC SIGNS @ $100.00/SIGN TRAFFIC SIGNS @ $ 50.OO/SH3N. TRAFFIC SIGNS & 5 SO.OQ/SIGN.
DAYS
3.
HRS
Ml
s_
*_
Temperary removal of traffic signs durina conwruction
- TRAFFIC SIGNS & SlOO.OO/StGN.
REMOVE a REINSTALL PERMIT NO.
ANNUAL SURCHARGE
REMOVE RELOCATE
T&S*
NUMBER OF FEET OF CURB SPACE fChai^eabfc) MORE THAN 25 FT 3U4.00 per FT
PARKING METERS
PARKING METERS @ S15C.00/METER-PARKING METERS @ S150.00/METER.
WARD
TOTAL: S