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�rr <br />1 <br />APPLICKHON <br />" <br />FOR THE USE OF CITY STREET LIGHTS FOR THE INSTALLATION OF BANNERS AND PROVISIONS <br />ALLOWING TEMPORARY CONhNUANCE OF 'SAME <br />Date: <br />APPLICANTINFORMATION <br />Applicant Name: <br />Business Name: <br />1. {± <br />Address: <br />�a f , 1- L C 3 <br />+LU <br />City/State/Zip: <br />V/ <br />Phone Number: <br />2—, S V o Fax No.: <br />Email: <br />cxOdet'..,, <br />INSTALLER'S INFORMATION <br />Business Name: <br />* , OP ,✓ <br />��' � _ L../� � � I'� �"�C'�"� J i./�... L <br />1sioy � <br />Address: <br />sc ;"'.W "y fit.- - L l <br />City/State/Zip: <br />Phone: <br />Fax No.: <br />BANNER INFORMATION <br />Banner Description: SICd " o <br />Banner Size: 2.L/ )( <br />r <br />Location of Installation:Ml'sac,42alz Auc <br />I <br />Period of Time for Installation: V 11 ` — / ///1 Event: <br />The above information is to the best of my knowledge accurate and correct with regard to the request to iooLc. <br />install banners on City of South Bend street lights. Attached to this application is a picture of the banner for <br />content at)nroval. A <br />Date: // / r Signature: <br />RETURN FORM TO: <br />Board of Public Works <br />1316 County -City Building <br />227 West Jefferson Boulevard <br />South Bend, IN 46601 <br />Phone: (574) 235-9251 <br />Fax. (574)235-917'1 <br />Submitted By: <br />Title: %I i` Y1C . T�;'-ec-4c <br />FOR CITY USE ONLY <br />RECOMMENDATION <br />Engineering <br />Building <br />Legal <br />Communications &'Special Projects <br />Other <br />