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Centerville <br />Special Event Pet-mit <br />- --- — ----- <br />k <br />NAME AND TYPE OF EVENT O - Nirc- <br />DAY, DATE AND TIME: Avi C11r <br />I. PARKS AND RECREATION DEPARTMENT <br />FINAL APPROVAL AND SIGN OFF <br />Signature <br />Date: <br />. ......... <br />Title <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 file to secure payment for applicant's obligation to the <br />City, <br />T Application is complete. <br />8. Special conditions are attached. <br />REVOCATION: Upon mutual consent, the City Council may revoke a special event permit if <br />the conditions set fourth in the permit application are not being followed. <br />Permit is hereby revoked: <br />Date: <br />Reason(s) for revocation: <br />Signature <br />Title <br />TO BE REVIEWED/APPROVED AND SIGNED BY AFFECTED <br />CITY DEPARTMENT HEADS <br />Page 6 of 10 <br />24 <br />