CITY OF CHICAGO ¦ BACP-PWU • BUNDLE PERMIT APPLICATION • Vl.04.28.10
APPLICATION TO USE THE PUBLIC RIGHT OF WAY
| ¦ L OFFICE USE ONLY
| DOB PERMIT *:
| AMNESTY ELIGIBLE? ? YES ? NO
APPLICANT INFORM A TION
LEGAL NAME OF ENTITY: S"u J ^ Q~&JrL. gXdTft-K- SoIa^^
PERMIT MAILING ADDRESS: M>ib L., J&Z_u, ,Jc P/xO~t>< f^^zJi
CITY: CA,.^^> STATE / ZIP CODE: Y„^ V if f
CONTACT PERSON: " g/ct V^ao-U.^— TITLE: ^ ~ '
PHONEr?-?^ g^yiy?] FAX: -7 -ix-Cr&f— *-fK>~7~\— E-MAIL: Z>ort^k frZl&/hSUd
BUILDING OWNER INFORMATION
NAME: S <-(^ ~QZ> IM PriL* j~7 *J uC*C~-i___
ADDRESS: *j X (_ ^/Lj/f/UQ P/yt2-*f /Zo
CITY: P,fo,c &rf(> STATE:_U-_ZIP CODE:/^^^ PHONE:-773 ^^^.OCFAX: 79^^Fr^67^- E-MAIL:
L/S£ OF THE PUBLIC WAY
1. List the proposed or existing use 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 each proposed use of the public way, which maps to scale the proposed use(s) 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 ofthe application, and the attachments herein, are true to thgjbasjt of my knowledge and belief.
TITLE: y&£<0~ri£*—-
SECURITY NUMBER: T.£0-Z*t.-0fALDERMAN'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.
ALDERMAN'S SIGNATURE:
DATE: ficJob-tr 13 I^jID // ^^fcC^.i 3g
CHICAGO
IMM^ Department of Business Affairs and Consumer Protection • Business Assistance Center lM&W%?§s% Public Way Use Unit • City Hall, Room 800 • 121 North LaSalle.Street, Chicago, Illinois 60602 cowu«!» p/o...
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