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City of South Bend Special Event Application MAY 10 2023 <br />Neighborhood Event <br />$25 application fee if filed 30 days or greater (up to 180 days) in advance of event <br />4 Bess_ <br />Please Brine 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 P (� <br />Date of Application: :5 1CO ZZ, Organization Name: <br />Applicant (Contact) Name: <br />Applicant (Contact)Phone: 5ontact Email: GwrICL _L-wf %314'J/r-�& Cpy�t <br />Address: �I 33 glS�se �[ City/State/ZIP: <br />Secondary Contact Name: 7p'e- f-y) IC Pe —a .I <br />ConrtactPhone9: �574- �O�°l(v%( Contact Email: c p <br />Address: 1l (�, e t [ S� City/State/ZIP: pL41- <br />• Section B - Event Information ^� <br />Event Name: Expected Attendance: !S <br />v , <br />Requested Street Closure: s a <br />From (Cross <br />To (Cross Str <br />Provide a brief description of the event: <br />w,P, W IV 60- &Jk b(r +-I M j 9 r64Y44 0(t. u . <br />Date of Event Setup [mm/dd/yy]: �0 1101 Time: 3� 0-\ <br />Begin Date of Event [mm/dd/yy]: % 1/0! Z3 Time: <br />End Date of Event [mm/dd/yy]: (p h O h 3? Time: D i'-N <br />Event Cleanup Completion [mm/dd/yy]: 61/ o h 7 Time: <br />Have all residents on the affected block have been notified and invited? es ❑ No <br />Please attach a copy of the door hanger or letter used to notify rreesidentsin addition to signature attachment. <br />• <br />Number of households fronting the proposed street closure: /�AIDA-.Q3 <br />Number of households represented by signatures <br />or attached sheet: PIA <br />Will this event have music (live other)? Yes ❑ No <br />