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 #:
AMNESTY ELIGIBLE? ? YES | D NO
APPLICANT INFORMATION ¦ .
LEGAL NAME OF ENTITY: A//J? l//lV/? /A/C- PS*?
PERMIT MAILING ADDRESS: ST/ST/ V- C^/l^lC^
JL- ZIP CODE:
CITY:
STATE:
CONTACT PERSON: V/ A/Q_D PHONE. 77?~17/~ yOOp FAX:
1*-
E-MAIL ^p*rrl/i WO*/'
BUILDING OWNER INFORMATION
NAME: P/ltiSZ/L tL. CL ADDRESS: Vgfr A/. 07/£SHT^ ?Z/fUA>40 STATE:
CITY:
PHONE: 3/2- 2C2-- /frOEAX:
ZIP CODE: ^ g?^ t^7"
E-MAIL:
USE OF THE PKBL/C WA V
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 MANX? 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: VlAfOPK- #t**9rtW9£— TITLE: /F^
F.E.I.N. or SOCIAL SECURITY NUMBER: 3-7- VIVJOOX ~
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 i6/ocated.
"ALDERMAN'S SIGNATURE: ^TM,
DATE:
tt
CHIC AGO
Jp Department of Business Affairs and Consumer Protection (BACP) • Business Assistance Center (BAC) iltoJT Public Way Use Unit (PWU) • City Hall, Room 800 • 121 North LaSalle Street, Chicago, Illinois 60602 ffiSffiw www.cityofchicago.org/bacp-
312.74.GOBIZ (744.6249) • 312.742.1974 (TTY)
ORDINANCE SIR SPA
Acct. No. 361060-1 Permi...
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