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<br />(i~~= <br /> <br />1. <br /> <br />Centerville <br />Special Event Permit Application <br />Tdli <br />TITLE, PURPOSE, AND BRIEF DESCRIPTION OF EVENT: j (lA <br />1X\y\ 6...+\0110 L-oIF -to I ner e t )t-. D) " t. \II t: to rlt. '. t J& )(:f) 0\- <br />Gc\ckn. f'\..'6jOCKtC\ \1')) I'xhSIY' ~ CJbl. Or \ ((I phDI\ . L-Nf) (I finO' r aH Ld S\lenl <br /> <br /> <br />New Application: <br /> <br />Renewal of or Change in Application: <br /> <br />x <br /> <br />CONTACT PERSON: Ju.\ito (Jt;idm <br />TELEPHONE: ~Sl :.J04 ~~~1 <br /> <br />OR (0 t)/. 10'6 - OI.PCG <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 />p1i.~ud of (i-'\l\d((f) <br />Title: PU-i'dI6NX I evml 1<;' ~I>(e" for <br /> <br />Applicant's Name: ~~ _ (tDfM(IJJ~ C~\ll lhLtXth <br />Address:1L31 {-;t),Hcf\ r-<'d LcntuV1\G. ~f0 c)Sf'/6'6 <br />Mailing Address: 0lffiJ <br />Affiliation: c~ Pb(\SDf or L H..nt <br />Day Phone: (9 ~) I- Ii;) (1 0 1 ~ ~ 1 <br />Emergency Phone: <br /> <br />Evening 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: 01. (;-tw'\(\ t'iJ" C ~D"L Ch.u' ch <br />Organization/Business/ Agency/Affiliation: E- HO \ s\)()I"'SOU C\ DIj 5\ (U\Lv'\.k 1/", S ((>..,4-%"\011 L <br />C\-u.ILl\ 'or 4~e. bCN-h1 of 4ht (--:t>ldtn .tc~)' <br />Is this a non-profit organization? ~ Yes 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: 0o..mJ g.'> ~{J <br />Day Phone: Evening Phone: <br />Title and functional responsibility with regard to the event: <br /> <br />Page 1 of 10 <br /> <br />;24 <br />