CITY OF CHICAGO BACP-PWU BUNDLE PERMIT APPLICATION -.V.09.28.10
APPLICATION TO USE THE PUBLIC RIGHT OF WAY
OFFICE USE ONLY |
DOB PERMIT tt: |
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AMNESTY ELIGIBLE? |
□ YES | □ NO |
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APPLICANT, INFORM A TION
LEGAL NAME OF ENTITY: C.t~f^)r\ <jf, ^ ^ N<& tC^N PERMIT MAILING ADDRESS: X. \ U- c,lrNt<-K /
CITY: <L\\\<__STATE: U ,/ ZIP CODE: kOLhO
CONTACT PERSON: Cg* jr£ ^ TITLE: PHONE: ' ~ B^ft^FAX: E-MAIL:
BUILDING OWNER INFORMATION
NAME: ADDRESS
name: t-og\5 |^E.U\Cfe <A J^frfiK ?qMK&
CITY: V^n^X^^IM STATE: )L\ ZIP CODE: PHONE: _FAX:_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, are true to the best of my knowledge and belief.
BY:
nowledge and belief.
ECUErtTY NUMBER: 1TI ~ j *j <j g $Jf\
TITLE:
F.E.I.N. oi
ALDERMAN'S APPROVAL
As part of this application process, you are required to notify/obtain approval from the Alderman in whose ward your proposed use of the public way j^|pcated
ALDERMAN'S SIGNATURE: WJ QJLAA^ ty_AJLA DATE:
CHIC AGO____
|2i>3]S3Sj30i Department of Business Affairs and Consumer Protection (BACP) Business Assistance Center (BAC) ■ pKB^iaS Public Way Use Unit (PWU) City Hall, Room 800 121 North LaSalle Street, Chicago, Illinois 60602 8S!aUSS!^S5A www.cityofchlcago.org/bacp 312.74.G0BIZ (744.6249) 312.742.1974 (TTY)