APPLICATION TO USE THE PUBLIC RIGHT OF WAY
APPLICANT INFORAAATION
LEGAL NAME OF ENTITY: ^ 5 5 if fijCOA D Ufi V L- L C PERMIT MAILING ADDRESS: IfBSLj AjV ft *nAoliw a-J CITYf'Uir.A^ STATE: XL*^ ZlP.^^n
CONTACTPERS&N: A-aj/u a 6-A LL/o S _TITLE: £,Uaa.£ U»Ue-z
E-MAIL:gjAi*jdL.@ (\/jjiAAi.jftc*
W.LSOAJ r COW ^»
PHONE: ,q- SQ5-7 FAX: 773 - 3 3?- 03 515
PROPERTY OWNER INFORAAATION
NAME: \AWj2./VZ^ 0 1 A<**> ftiMn_
ADDRESS: If Wfi> AJ, MAfrHfe. 0*., Ap^T. /8£-
CITY: d^.c-A^.o_STATE: XL,_ZIP: &q£ /?
USE OF THE PUBLIC WAY
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 to 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 4.
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/tne. best of my knoy
.ElN.>r SOCIAC^ECURITY NUMBER: UutUaLA-A%Wl
BY_ U.N/frr SO ^
ALDERAAAN'S APPROVAL
As part of this application process, you are required to notify/obtain approval from the Alderman in whose ward your proposed use^f trjp public way isjocatsd.
ALDERMAN'S SIGNATURE
DATE: iO^jjlQ WARD: c/^
CHICAGO_____ -
U City of Chicago I Department of Business Affairs and Consumer Protection | Public Way Use Unit BinrnEssAFFAiJr Business Assistance Center | City Hall, Room 800 | 121 North LaSalle Street | Chicago, Illinois 60602 raSwawonentA www.cityofchicago.org/bacp | 312.74.GOBIZ (744.6249) | 312.742.1974 (TTY)