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• <br />11 <br />• <br />City of South Bend Special Event Application APR 0 4 1013 <br />o. <br />z Neighborhood Event <br />z <br />` At $25 application fee if filed 30 days or greater (up to 180 days) in advance of event. <br />Please Bring Completed Application and Payment to: <br />Public Works Service Center, 731 S. Lafayette Blvd., South Bend, IN <br />Review the Instructions on the Special Events page before completing the application. Neighborhood Special <br />Event applications must be submitted more than 30 days in advance of the event date or the application will not <br />be accepted. <br />Section A - Applicant Information <br />Date of Application: j�7 /�% Organization Name: euJP_e I �� t � V <br />Applicant (Contact) Name: R'M{ C. cl�) ! eQ er— <br />Applicant (Contact) Phonef5711-V{S 6"4'9R Contact Email <br />Address: `&(O 1UN141 e4 S/- City/State/ZIP: f5OUftl Rend 77,1\1 <br />Secondary ContactNameaciAeV 1jS-q <br />Contact Phone:(574Q2SGg9 ZI Contact Email: �L;//al\CYjor)YzCirlapA-enH <br />Address: ` O'7u,,,&)HP �f 4 City/State/ZIP: `�c01h, Cnrt�Sa.1gU/9 <br />Event Name: �r�d�e7 �JWe_e� 16L2nr+Expected Attendance: <br />Requested Street <br />From (Cross Street): (j 1 k I S T <br />To (Cross Street): M c C A e f <br />Provide a brief description of the event: <br />Date of Event Setup [mm/dd/yy]:n:ZAI/23 Time: -i.\CM }O 3o <br />Begin Date of Event[mm/dd/yy]: QM2I&S Time: 17_'. cnnoo <br />End Date of Event [mm/dd/yy]: 07/0 / /Z3 Time: h9 3' Qwr <br />Event Cleanup Completion [mm/dd/yy]:07/C4I12Z Time: ci' P;*( <br />Have all residents on the affected block have been notified and invited? ['Yes ❑ No <br />Please attach a copy of the door hanger or letter used to notify residents in addition to signature attachment. <br />Number of households fronting the proposed street closure: <br />Number of households represented by signatures on attached sheet: <br />Will this event have music (live or other)? U(Yes ❑ No <br />