11/03/2003 11:10 FAX 312 745 2958
OBAL PUBLIC WAY USE
g|003/01«
APPLICATION TO USE THE PUBLIC RIGHT OF WAY
APPLICANT INFORMATION
LEGAL NAME OF ENTITY. ,-Cg.A rv_S
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PERMIT MAILING ADDRESS:
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CITY: C* k a C Aj ft STATE: -XV/,'a/ o S ZIP CODE: & 0 £ 1/ ) CONTACT PERSON: _TITLE:
PHONE: 3 Q^/W33/ FAX:"7 73-£3£-ym E-MAIL: ffttA/O fr, /Ce) k(l @>
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USE OF THE PUBLIC WAY
1 List the proposed or existing use below and complete the worksheel on page 3. Use only one application per public way use type.
TYPE
HOW MANY? BUILDING ADDRESS
LP3 o uj<
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.
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 port ofthe application, and the attachments herein, are true^Jhe best c^mv^tnowlqchjp and belief.
BY:
F.E.I.N. or SOOALSSeWTY WMSER:
title: 0<'stV.c4 F*c; h f y
ALDERMAN'S APPROVAL
As part of this application process, you are required lo notify/obtain approval from the Alderman in whose ward your proposed use ofithe public way i located.
ALDERMAN'S SIGNATURE ~J Prffi-l did. JT WARD 4£ DATE/J~j3-d> j
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H I C A C O
City of Chicago | Department of Business Affairs and Consumer Protsction | Public Way Us© Unit swtMwwiii, Buiinoss Assistance Center | City Hall, Ro i BOD | 121 North La5all« Street | Chicago, Illinois 60602 rfu«M wonenoN www.cityofch1cago.org/bacp | 312.74.GO Z (744.6249) | 312.742.1974 (TTY)
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