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<br />JAN 26 2004 13:13 FR ARTESYN ENGINEERING 6123926740 TO 96514298629 <br /> <br />P.07/11 <br /> <br />If there is a fee or donation required as a condition of attendance or participation of this event, <br />please describe the amounts to be collected from various categories of participants or spectators: <br />A Fe.~tival Dance Button ore-purchase fee of $6 or a $8 day-DE-event fee. Thinking about making <br />kids under 18 free. <br /> <br />14. If a donation is requested on a purely voluntary basis, describe how you intend to inform <br />participants/spectators or others that they may participate in the event whether they make a <br />donation or not: N/A <br /> <br />Centerville <br />Special Event Permit <br /> <br />NAME AND TYPE OF EVENT: <br /> <br />DAY, DATE AND TIME: <br /> <br />1. PARKS AND RECREATION DEPARTMENT <br />FINAL APPROVAL AND SIGN OFF <br /> <br />Signature <br /> <br />Title <br /> <br />Date: <br /> <br />Please check or use N/A (not applicable) where appropriate: <br />1. _ Final check has been made of application requirements. <br />2. _ Event is approved by City Council. <br />3. _ All required permits are issued and on file. <br />4. _ Refundable clean up fee has been paid. <br />5. _ Insurance Certificate is on file with City Clerk <br />6. _ Surety Bond is on me to secure payment for applicant's obligation to the <br />City. <br />7. Application is complete. <br />8. Special conditions are attached. <br /> <br />REVOCATION: Upon mutual consent, the City Council may revoke a special event permit if <br />the conditions set fourth in the pennit application are not being followed. <br /> <br />Permit is hereby revoked; <br /> <br />Signature <br /> <br />Title <br /> <br />Date: <br /> <br />Reason(s) for revocation: <br /> <br />Page 6 of 10 <br />