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C Centerville <br />Special Event Permit Application <br />1. TITLE, PURPOSE, AND BRIEF DESCRIPTION OF EVENT: tom/ l; GOUT <br />G�t/NG�J' <br />New Application: Renewal of or Change in Application:'") <br />CONTACT PERSON: �i " A/&..5oyJ <br />TELEPHONE: 651- Io53 — b -f- OR <br />2. IDENTIFYING INFORMATION: <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 />Applicant's Name: i5p-14ri &rlw Cy Title: Sco -,T / Url <br />Address: <br />Mailing Address: <br />Affiliation: <br />Day Phone: 41 50 1 3 Evening Phone: <br />Emergency Phone: <br />3. EVENT PRINCIPALS: <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 />Name: No tv� -- St4. *Uo vd.. <br />Organization/Business/Agency/Affiliation: <br />Is this a non - profit organization? Yes <br />No <br />If you are making application under non -profit status, proof of non - nrofit status must be attached to this annlication <br />Mailing Address: <br />Day Phone: Evening Phone: <br />Title and functional responsibility with regard to the event: <br />Page 1 of 10 <br />20 <br />