CITY OF CHICAGO BACP-PWU BUNDLE PERMIT APPLICATION V.09.28.10 -
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APPLICATION TO USE THE PUBLIC RIGHT OF WAY
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DOB PERMIT #: |
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AMNESTY ELIGIBLE? |
□ YES |
□ NO |
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APPLICANT INFORMATION
LEGAL NAME OF ENTITY:
PERMIT MAILING ADDRESS: 39IL AJ.^kl^d A\jc
CITY: CAi tac,* _STATE:
CONTACT PERSON: G>,»ri^ Ctt*
ZIP CODE: ^c>g/?
&SL.
TITLE: fi^Mit M«lh
PHONE: (,1a OO? (t
FAX: 77? y<>rfr»7£_E-MAIL: e/,*^ £
BUILDING OWNER INFORMATION
NAME:_P
ADDRESS: AJ, Ml^tfTtt
CITY: g*.,,^
STATE: X*,
PHONE: . jfljo FAXT773 *r 69^2
ZIP CODE: 606/?
E-MAIL:
USE OF THE PUBLIC WA Y {
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 of the application, and the attachments herein,
ECURITY NUMBER: 2.Q- <TC/)9/9A
ALDERMAN'S APPROVAL^
As part of this application process/jf?>u are required to notify/obtain approval from the Alderman in whose ward your proposed use onfle public wa/is Locatec
ALDERMAN'S SIGNATURE_;_-_^n
DATE:
CHIC AG O
Department of Business Affairs and Consumer Protection (BACP) Business Assistance Center (BAC) Public Way Use Unit (PWU) City Hall, Room 800 121 North LaSalle Street, Chicago, Illinois 60602