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� '� • <br /> �� Centerville <br /> Special Event Permit Appl�cation <br /> l. TITLE, PURPOSE, AND BRIEF DESCRIPTION OF EVENT: Gv4 SL�T <br /> � C..It�rh,n� ��LIL <br /> New Application: _� Rcnewal of or Change in Application: <br /> CONTACT PERSON: ''T�'a � � ru-t �-J <br /> TELEPH4NE: l.g'� -t�'3 -y7$� OR GS! -¢1�-�tti� <br /> 2. IDENT[FYING INFORMATION: <br /> A� a written communica�ion from the organi�ation(s) in whosc name thc evcnt witl be advertised which <br /> suthoriaes y�on, the applicant� W apply fiar this special event permit on its/their bd�alf. <br /> ApplicanYs Name: S1�L L o iJ Title: �/}cit Sc�+ur' /3'►'►�1'��� ' <br /> i <br /> Add�+ess: I <br /> Mailing Address: ' <br /> Aflilialtion: <br /> Day Pha�: l�� Z- -'8�T `�1'f" Evetiing Phone: <br /> Emergency Phone: <br /> 3. EVE[VT PRIAiCIPALS: <br /> �'ollo�eg, pk�se list d�e mmcs, add�s and te.kphone numbas of all the principals in�olved in auy of the <br /> propo�od s�oQal cva�t- I�dc I�f+essio�al eva►L �nizess, ev�ent ptomotas, financial m�daaailas, c�mmei�cial I <br /> spo�ws, dmaitablae a� fi� wlase 6eaefii Wc cveat is b�og Ptuduood. ihe organ��tion(s) in wf�ose aame the <br /> e�nt i� 6cinffi ad�tisoc� aid aU ofhux administ�xtiv�iy, fmanc'ratty and org�nni�donalty mvaheoed a� principats in , <br /> de� of d� pnupoaod apeciat av�t M�ke additional c�pies of the follovvmg as needod tn include as of the <br /> p�pak ��*�i�md i� d� piopo�d �aI ev�r. <br /> Naa�e: - S � �t6o,�r - <br /> Ot�aai�ion�Buseaess/A.gettc,ylAffiliation: <br /> Ls this a��it organizaltion? Yes Nfo <br /> �!'� ���� �' �� �. P�f of no�e-piofi¢ s�h�dhRS o�tst. be alwadeod b Il�is a�qplication <br /> Mailit� �1dd�s: <br /> D� PB�cen� Euening Phaie: <br /> "i''iHe � �aon�t veid� r�u�d � d�e c�aent <br /> P� � of �� <br /> 23 <br />