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terville <br />m- CITY OF CENTERVILLE <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 />00 OPP f-a�l Q4 In c� 1�� l M vi <br />Address (Street, City, State, Zip) wwa 3 t <br />Email Address: W vvf,/ jD Iio e ri , L4Vo <br />Type of Event: <br />Run/Walk <br />Block Party <br />Parade <br />® Street Fair <br />14AA41A�-- 2(e. �2p t <br />Date of -vent <br />Name or Title of <br />Name of Applicant or Contact Person <br />U4 (;-I • 2.v0 1 L/ <br />Phone Number <br />OPlanned Demonstration <br />OCeremony <br />O Concert <br />50— 1 i -y <br />Anticipated Attendance <br />O Fundraiser <br />Celebration <br />Other Db.E1n Sf .-�w <br />dt-�;cy✓ I IGvuy <br />Event Hours G— 172A h, <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 />- T7-nx 12v'" +� "412A -h b -e Uol-el- <br />NOTE: No 0ermar exit m rkings.q-4 , tl vu r . r %s#rhe# _sii ewa)ks;-ar tr ils r"t - i ±";q rkdll <br />1) Are police officers needed to provi ervice the event (traffic control, security, barricading streets, <br />and use of equipment, etc.) Yes NoJF . <br />a. Police Security 0 <br />Police Traffic Control 0 <br />Barricac e <br />Cones . 0 <br />Barricade 0 <br />Picnic Tables (@ Parks Only) 0 <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 />14 <br />