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ten,-dfe <br />zsratfx�hPIf,xr CITY OF C E N TE RVI L LE <br />SPECIAL EVENT PERMIT APPLICATION <br />Please read information on applying for Special Event Permit before completing this application. Please be <br />mindful that fees may be associated with your request. Answer all questions (please print). Write N/A (Not <br />Applicable) where appropriate. <br />Sponsoring Organization <br />) Hca S/—?r-cc h <br />Address (Street, City, State, Zip) <br />Name of Applicant or Contact Person <br />t&b( LQ!�p 3 �lQal <br />Phone Number <br />Email Address: h0.( =?SA CCx.}5don 0 sit' o Q , coyy) <br />Type of Event: <br />Q Run/Walk <br />Block Party <br />O Parade <br />Q Street Fair <br />Date of Event <br />Name or Title of Ever <br />Q Planned Demonstration <br />Q Ceremony <br />Q Concert <br />-71b- lob <br />Anticipated Attendance <br />Q Fundraiser <br />Q Celebration <br />Q Other _ <br />Event Hours — <br />Location and Description of Event: (List any City parks, streets, trails or facilities to be used and/or blocked -off during the event) <br />\r-�©C,� nCL-Aft*1� 1� <br />�v-� lv-c'K , J <br />NOTE: No permanent markings of route allowed on any streets, sidewalks, or trails in the City of Centerville. <br />1) Are police officers needed to provide services at the event (traffic control, security, barricading streets, <br />and use of equipment, etc.) Yesc2L. No <br />a. Police Security <br />Police Traffic Control <br />Barricades <br />tarri ad <br />Picnic Tables (@ Parks Only) <br />2) A map or diagram of the event must be provided. Looking for routes/direction of travel, locations of <br />restrooms, serving areas (food and alcohol), stages, fencing and barricades. <br />Imo- 4-- 1-0�S <br />22 � 'o -c -Ale' <br />