APPLICATION TO USE THE PUBLIC RIGHT OF WAY
APPLICANT INFORMATION
LEGAL NAME OF ENTITY: 3g h j M ¦ ^\t{nQ^ §Ud f\£\rdv'P PERMIT MAILING ADDRESS: Qfikj.tTj'ft StU^f '
CITY: '^ClO^e STATE: (Li . ZIP: toQQ
CONTACT PERSON: E>ttA,A-|U (IFKb/VM _ TITLE: ^ntOfmaYtflPe
PHONE: rfft) M-^H'Ht^ FAX: I^PK? M^^W^S E-MAIL: gja^ippqj 1
PROPERTY OWNER INFORMATION
" NAME:_3Sj>| rQ • £jLf yyt 0 P^UJ7\M^ lu^_
ADDRESS: hff ^ to VjOX-tQA tUjjt.T . CITY:. C^.oio'p
USE OF THE PUBLIC WAY
' List Ihe proposed or existing use(sj below, and complete trie worksheet on page 3. Use only one application tor all public way use type.
TYPE_ HOW MANY? BUILDING ADDRESS _ _
2. Please enclose one sketch of proposed use of the public way, which maps to scale ihe proposed use and ils relationship to surrounding right-of-way. All measurements must be indicated.
3. All "No Fee" items require a S50 application fee. Please remit with application.
i "No Fee" items are listed in the price list on page A.
5. The prints should also accurately depict the location of the property line and public facilities (meters, iighi poles, sidewalks).
torn
APPLICANT CERTIFICATION
art of the application, and the et.
I hereby certify that all statements made as part of the application, and the attachments herein, are true to the best oflmy Knowledge and belief.
BY:_^—^ ' <----_ _TITLE:
F.E.I.N. or SOCIAL SECURITY NUM8ER: lp fa - "^S C\ Q ( Q-f
ALDERMAN'S APPROVAL
As part of this application process, you are required to notify/obtain approval from the Alderman in whose ward your proposed usa of the public way is located.
W-S.SIGNATURE: WUU QwSJIM_, „
ALDERMAN'S SIGNATURE: DATE:
City of Chicago I Department of Business Affairs and Consumer Protection I Public w«y use Unit to&mtss *Fr^iR3a Bus'nes3 Assistance Center | City Halt, Room BOO I 1*1 North LaSalle Street I Chicago, Illinois 6060? tOKmna(*euc&\ vvvw.u'tyofchicago.o...
Click here for full text