Non Res Block Party - La Casa de Amistad

Home Browse Search

APPLICATION R USE OF AND BLACKING OF ACfCESS ZQ, THE PUBLIC SIGHT-QF--WAY FOR NON-RE,SIDENU) AL BLOCK PARTIES The Board of Public Works must have FOUR (4) weeks prior notice of the event. A NON-REFUNDABLE APPLICATION FEE OF $125.00, IN THE FORM OF A CERTIFIED CHECK OR MONEY ORDER, PAYABLE TO THE CITY OF SOUTH BEND, MUST BE INCLUDED WITH APPLICATION. ❑ Fee Paid Applicant Name: l.a Casa de Amisiad Address: 3� � S . H4--1*T City: State: 1 rd Zip: t; (o/ 9 Phone: 5"+4_03-z_l_zo [ocF�c�� 6t�.0b.0042 This application is made to the City of South Bend, Indiana, Board of Public Works, for the rasc of the specified public right-of-way by Applicant for the holding of the hereinafter described event: Event Name —'I�sT-' V\/�"DNC5-rom . t-ve fZ Location 2-1 4 0 -Soc c V4. W-5T f2" /-Jta . (Describe: Atea/Route) Street Closure Name of Street From T4 Date of 1{ vent M A-d '3 I 20 117 Time. Registration/Setup ❑ pan. Approximate Number of Attendees 11000 4 Answer the following appropriately: ❑ a.tn. ❑ R.M. Start ap.m. End _ _ WPM. L This event will have music (five or other). Yes ❑ No a. I understand the Noise Ordinance described in the Agreement/Permit Yes ❑ No 2. Required Information to Accompany Application a. Certified Check or Money Order in the Amount of $125.00, or: b. For Certified Nonprofit Organizations: Copies of the 501(c)(3) Internal Revenue Exemption Status Document and a current copy of Form 990 of Form 990-EZ are included with this application, and Yes ❑ No additionally filed with the Office of the City Clerk, a Floor, County - City Building, 227 W. Jefferson Blvd., South Bend, Indiana. c. Certificate of Insurance 3. d. Maps, drawings of the area and setup plan 0 Yes Q No a. This event involves City streets 0 Yes ❑ No b. This event involves County roads ❑ Yes ❑ No c. This event involves State highways ❑ Yes ❑ No d. This event involves the use of the sidewalk 0 Yes ❑ No Updated 4/2015 1