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Downtown Furnishings Request Form

2. Village of Skokie
   Community Development Department (847/933-8447)
3. 
5. Downtown Furnishing Request Form
7. Requester Information
9. Name:*
10. Telephone:
12. Street Address:*
13. Fax:
15. City, State:*
16. Zip:*
17. Email:
19. Downtown:

    1. Business Owner
    2. Resident

    1. Shopper

    1. Visitor

    1. Commuter/Employee
21. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
23. Signature of applicant or authorized officer/agent confirming that all information on this application is accurate and correct.*
24. Date:
26. Business Owner Information (if "Business Owner" is selected above)
28. Name of Business Owner:
29. Telephone (daytime):
31. Authorized Officer or Agent:
32. Telephone (evening):
34. Address:
35. Fax:
37. City, State:
38. Zip:
39. Email:
41. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
43. Signature of owner or authorized officer or agent consenting to business owner’s furnishings request.
44. Date:
46. Furnishing Request
48. Furnishing Location
    Address of Property Closest to Furnishing Location
50. Type of Request:

    1. New Installation
    2. Maintenance
    3. Other
51. Public Furnishings

    1. Red Bench - "Skokie"
    2. Red Bench - "Downtown"
    3. Rectangular/Square Planter Pots
    4. Round Planter Pots
    5. "S" Bike Rack

    1. Trash Receptacle
    2. Recycle Receptacle
    3. Banner
    4. Hanging Flower Pot
    5. Other
53. If other, please explain:
54. If other, please explain:
56. Private Furnishings:

    1. Bench

    1. Planter Pots

    1. Cafe Tables and Chairs
58. Submittal Requirements
60. 1. Site Plan: The location of the furnishings must accommodate this request form. Please visit http://www.skokie.org/Maps.cfm and select the “Geographic Information System (GIS)” link. Enter the address listed on the previous page in the address box, select the “Print View” link above the address box, select “View in PDF”, add the address in the title box, and print to PDF. After the PDF is saved, print the PDF, locate the furnishing(s) by hand, and add the notes necessary to assist with processing this request.
62. 2. Photos: Photograph the preferred location of a new installation or photograph the existing furniture in need of maintenance. Provide enough context (buildings, trees, etc.) so staff can identify the specific location.
64. 3. Private Furnishings (only if selected on previous page): Must indicate the style and material of all furniture (no plastic). Include photos or product cut sheets.
66. Please upload the above documents here.*
    An application is not complete until all necessary documents are received.
Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit Submit and Print

* indicates a required field