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Centei <br />Special Event Permit Application <br />2 <br />3 <br />TITLE, PURPOSE, AND BRIEF DESCRIPT 5 <_ <br />'r� ON OF EVENT: 1 4 <br />1'r b C <br />New Application: LX Renewal of or Change in Application: <br />CONTACT PERSON: /)),t <br />TELEPHONE: R <br />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: 114r. r Address: P6 '60->NC i <br />Mailing Address: . t, <br />Affiliation: pyc' d f et / <br />Day Phone: 56-7— (,,qj <br />Emergency Phone. 5'0'7— <br />EVENT PRINCIPALS: <br />,,, e <br />On. a Titic: <br />Ale <br />/77A/ � Wt) 5 <br />,232� Evening Phone: <br />G -1q- Q 3P�2. <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- x&1 f MAC _rs <br />Organ izationtB us iness/Agen cy/AfWiati on: <br />Is this a non-profit organization'? H Yes � No <br />If you are making application under non-profit status, Droof of non-Drofit status must be attached to this armlication <br />/I <br />Mailing Address: t Cr,3 <br />Evening e <br />Day Phone- <br />Title and functional res onsibility with regard to the event: a tNe enAO14 Nt V" 4 <br />6LA : /(3 ) i.N T( 5 - 5 <br />Page I of 10 <br />19 <br />