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<br />\..-.:> <br /> <br />a.ooF <br /> <br />(i~ <br /> <br />Centerville <br />Special Event Permit Application <br /> <br />1. TITLE, PURPOS~ AND BRIEF DESCRIPTION OF EVENT: ~ <br />~k (11~ - Ju--noI ~L/ <br />, <br /> <br />New Application: v- <br /> <br />Renewal of or Change in Application: <br /> <br />CONTACT PERSON: to.- ~ Mn<. ~ 'nzt)-itz <br />TELEPHONE: /,;5/~ 7s-s-- 8'A.6~ OR -:ilL /tn"-1 &.ifrr f/Ol-t.J~'1-7f"37 <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's Name: &-u bt'A- /n dtL <br />Address: (PQi/5 f'1~jt1h, J?d .,;. <br />Mailing Address: elt;> 70e7 &'-L'~U <br />Affiliation: l MU/1'nk'Ol- ' <br />Day Phone: (;t)/- '766 - ~ ::i.5t, Evening Phone: <br />Emergency Phone: <br /> <br />Title: ?tiluc. &.,~ <br />/1;33 ~ ~. <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, fmancial 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: .;)-1. '-1' tnn ~~~ <br />OrganizationfBusiness/ Agency/Affiliation: <br />SJ. ~~~ ~ <br />Is this a non-profit organization? ~ Yes <br /> <br />No <br /> <br />If you are making application under non-profit status, proof of non-profit status must be attached to this aoplication <br /> <br />Mailing Address: 1087 ~'7?d <br />Day Phone: ~S7 - if ~ 1- 7q 3 1 Evening Phone: <br />Tit! and functional.!:tsponsibility with regard to the event: <br />7'trn1 ~' - ~ <br /> <br />~~ J4~,P~ <br /> <br />Page 1 of 10 <br /> <br />,ZZ6 <br />