CITY OF CHICAGO • BACP-PWU • BUNDLE PERMIT APPLICATION • V.O^&.IO
APPLICATION TO USE THE PUBLIC RIGHT OF WAY
| ;„ ¦ OFFICE USE ONLY
DOB PERMIT #:
| AMNESTY ELIGIBLE? ? YES | ? NO
APPLICANT INFORMATION
LEGAL NAME OF ENTITY: To\nl~^\^\ M^i'CQ/\ Co.'l'^-
PERMIT MAILING ADDRESS:_? ( |Q . fl^Qgn^o!/_
CITY: rMj'CcxO^> STATE: Tl._ ZIP CODE: £Q£ i{Q
SCW~ Ica^e, /Wo ^u^o . TITLE:
CONTACT PERSUTM: 1 qw^ e, PHONE: jyi fW /far-* FAX?
e-mail 1^^,^ HM^/ 5 yric*
BUILDING OWNER INFORMATION
NAME:
ADDRESS: t/t/,3/
CITY: ^aiCA^fl
PHONE
2M
33.^
STATE: r£L_
ZIPCODE: ^DMn
E-MAIL:
i/SE 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?
9-
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 CERTIFICA TION
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:^oe^ hwlfito IKJiY, Al-4TO-S?CjTITLE: ?feM,)^T OUO^ , F.E.I.N. or SOCIAL SECURITY NUMBER:__
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/thepublic way is located.
ALDERMAN'S SIGNATURE:
DATE:
SIG NAT
WARD:
I'ltTVOTni Department of Business Affairs and Consumer Protection (BACP) • Business Assistance Center (BAC) I »MLdL Public Way Use Unit (PWU) • City Hall, Room 800 • 121 North LaSalle Street, Chicago, Illinois 60602 c$suM«feoron«w www.cityofchicago.org/bacp- 312.74.GOBIZ (744.6249) • 312.742.1974 (TTY)
Page ...
Click here for full text