CITY OF CHICAGO BACP-PWU GRANT OF PRIVILEGE PERMIT APPLICATION V.05.27.10
APPLICANT INFORMATION
LEGAL NAME OF ENTITY:
PERMIT MAILING ADDRESS: » ^jOy. S^iS S ~f
CiTY.C
CONTACT PERSON:
STATE: TC\-
ZIP:
PROPERTY OWNER INFORAAATION
NAME: VJlfo
ADDRESS: Kj ^Pl
CITY:
STATE:
USE OFTHE PUBLIC WAY
ZIP:
1. List the proposed or existing use(s) 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 proposed use of the public way, which maps lo scale the proposed use and its relationship to surrounding right-of-way. All measurements must be indicated.
3. All "No Fee" items require a $50 application fee. Please remit with application.
4. "No Fee' items are listed in the price list on page 6.
5. 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 bf/frNonpwtedge and belief.
_TITLE: frSOCftgfrfry MftV^frS
F.E.I.N. or SOCIAL SECURITYNUMBER: ^(k- SSI"7 ' * J
ALDERMAN'S APPROVAL
As par: of this application process, you are required to notify/obtain approval from the Alderman in whose ward your proposed useyof thjs public wa* is Tbe
ALDERMAN'S.SIGNATURE
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DATE:
WARD
City of Chicago I Department of Business Affairs and Consumer Protection | Public Way Use Jnit Business Assistance Center | City Hall, Room 800 I 121 North LaSalle Street I Chicago, Illinois 60602 eaSSmfS^A www.cityofchicago.org/bacp I 312.74.G03IZ (744.6249) I 312.742.197* (TTY)
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