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<br />------------ ------------ <br /> <br />.. <br /> <br /> <br />CenterviUe <br />Special Event Permit Application <br /> <br />1. <br /> <br />~LE, PURP~SE'~dRIE;F D~RlPTION OF EVENT: <br />klAlI//; (!. ~ell '(1/{/ ~ y. FU//ILJ 7(~l5tL <br /> <br />New Application: <br /> <br />v <br /> <br /> <br />Renewal of or Change in Application: <br /> <br />-&~ <br />R <br /> <br />CONTACT PERSON: <br />TELEPHONE: ~ 6/- ? <br /> <br />2. IDENTIFYING INFORMATION: <br /> <br />Attach a written communication from the organization(s) in whose name the event will be advertised which <br />authorizes you, the applicant, to apply for this special event permit on its/their behalf. <br /> <br />APPlicant'SName:~. Ti~6,~ <br />Address: b9~5 . "I'__ta:Jtl&'7 7V/ <br />Mailing Address: 'C) B' . <br />Affiliation: L-4'11.;~ <br />Oay Phone: 1#57- '155- J' ~ 5 (p Evening Phone: <br />Emergency Phone: <br /> <br />3. EVENT PRINCIPALS: <br /> <br />Following, please list the names, addresses and telephone numbers of all the principals involved in any of the <br />proposed special event. Include professional event organizers, event promoters, financial underwriters, commercial <br />sponsors, charitable agencies for whose benefit the event is being produced, the organization(s) in whose name the <br />event is being advertised, and all others administratively, financially and organizationally involved as principals in <br />the production of the proposed special event Make additional copies of the following as needed to include as of the <br />principals involved in the proposed special event. <br /> <br />Name: Sf ~ &~ <br />Organization/Business/ Agency/Affiliation: <br /> <br />",., Yes <br /> <br />No <br /> <br />Is this a non-profit organization? <br /> <br />If you are making application under non-profit status, proof of non-profit status must be attached to this apDlication <br /> <br /> <br />Page 1 of 10 <br /> <br />3j~ <br />