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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 />Quad Area Chamber of CommerceMichelle Koch <br />Sponsoring Organization Name of Applicant or Contact Person <br />PO Box 430763-786-9672 <br />Address (Street, City, State, Zip) Phone Number <br />michelle@mainstmarketers.com <br />michelle@mainstmarketers.com <br />Email Address: _________________________ <br />Type of Event: <br />Run/Walk Planned Demonstration Fundraiser <br />Block Party Ceremony Celebration <br />Senior Expo <br />Parade Concert Other <br />Street Fair <br />5/18/2325010-1 <br />Event Hours <br />Date of Event Anticipated Attendance <br />Senior Expo <br />Name or Title of Event: <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 />St. Genevieve Community Center <br />________________________________________________________________________________________ <br />________________________________________________________________________________________ <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 />5 <br />and use of equipment, etc.) Yes ___ No ____ <br />0 <br />a. Police Security____ <br />Police Traffic Control____ <br />0 <br />Barricades____ <br />0 <br /> Cones ____ <br /> Barricades ____ 0 <br />Picnic Tables (@ Parks Only) ____ <br />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 /> <br />