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<br /> <br />ervi[[e <br /> <br />CentervilIe <br />Special Event Permit Application <br /> <br />. <br /> <br />1. TITLE, PURPOSE, AND BRIEF DESCRIPTION OF EVENT: <br /> <br /> <br />New Application: 'I. <br /> <br />Renewal of or Change in Application: <br /> <br />CONTACT PERSON: <br />TELEPHONE: <br /> <br />l~ory\e." 'S+-'SojAVe, Or- :J\~A'i <br />OR toSI- b53- 8'3b2-- <br /> <br />\J\o(\hl VI <br />(.,,51-b5:l.()~7 <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 pennit on its/their behalf. I <br /> <br /> <br />~~::~t';~~ ~~V\J~~LDcr;f.<7~~1[ O~~t!:{cl.e- <br /> <br />Mailing Address: <br />Affiliation: ',till D I j).J W <br />Day Phone: (.,61-<0 5 ~ _ ol?'51 Evening Phone: Saw.-e -' <br />Emergency Phone: b~ I ~ 3 43.- II 00 <br />... . <br /> <br />3. EVENTPRlNCIPALS: <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: _Ln'((\ f' 4. so.u~e.r <br />Organization/Business! Agency! Affiliation: <br /> <br />Is this a non-profit organization? <br /> <br />-!1l- Yes <br /> <br />--.::;L 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: Jg~D (le...,,}ey-S+ ~iI\.\€xvi\\Q 'HN 5503R' <br />Day Phone: kS) _ f..5~ - g3(, 2- Evening Phone: :1~ <br />Title and functional responsibility with regard to the event: De t ~ f..p rep h'~ <br /> <br />Page I oflO <br />