APPLICATION TO USE THE PUBLIC RIGHT OF WAY
APPLICANT INFORMATION
LEGAL NAME OF ENTITY: ,^Md&fiJ UjQflPftS?_
PERMIT MAILING ADDRESS: S . 'HaJs^fi/ _
CITY: STATE: li^ ZIP CODE:
CONTACT PERSON: GMDLM MfMlAfr TITLE: Mfifc VrWrVjOf
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PHONE
USE OF THE PUBLIC WAY
id complete the worksheet on page 3. jse type. {
1. List the proposed or existing use below and complete the worksheet on page 3. r / /
Use only one application per public way use type. K /" 0^
TYPE HOW MANY? BUILDING ADDRESS
2. Please enclose one sketchof 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.
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.
e bejst of my knowledge and belief.
?b-mated
BY
T.E.r.N/br SOCIAL SEfcORITY NUMBER
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.
WARD
OAN'S SIGNATURE
CHICAGO
m
f^JP City of Chicago | Department of Business Affairs and Consumer Protection | Public Way Use Unit Ej5jj"Jjj^*5i Business Assistance Center | City Hall, Room 800 | 121 North LaSalle Street I Chicago, Illinois 60602 coNjuMfuMorKTioN www.cityofchicago.org/bacp | 312.74.GOBIZ (744.6249) | 312.742.1974 (TTY)