Special Event - 4th of July Fireworks - July 4

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11 • �1 City of South Bend Special Event Application Neighborhood Event t ?' $25 application fee if filed 30 days or greater (up to 180 days) in advance of event. Please Brine Completed Application and Payment to: Public Works Service Center, 731 S. Lafayette Blvd., South Bend, IN Review the Instructions on the Special Events page before completing the application. Neighborhood Special Event applications must be submitted more than 30 days in advance of the event date or the application will not be accepted. Section A - Applicant Information Date of Application: S- i Ll - X Organization Name: V/P Applicant (Contact) Name: /'0 c N�/ d Y R O� e/ I �5 Applicant (Contact) Phone: P "2q);-sa- 6 o a 6 Contact Email: n 0 rs+ Address: 7 o q A I Le N ST City/State/ZIP: SatiT /4 Be- N/l -I- N yb 1v�6 Secondary Contact Name: Contact Phone: Email: Address: City/State/ZIP: 11 _ Section B - Event Information Event Name: jrl I�I U F ill I Y rl' IZ < W oj� Kixpected Attendance: Requested Street From (Cross Street): j IQ ps ey s 7-A N 0 / To (Cross Street): y A P% 8 of Q-e to s/ A r D A 5 T Provide a brief description of the event: '-ITH OF JL4I y F, rye voRf< SN ow Fo� I`H�fiat P?OHboRHood Date of Event Setup [mm/dd/yy]: '2 Time: Begin Date of Event [mm/dd/yy]: 7 / _ °2 Time: )t30?/Y7 7 . S o 1-0 End Date of Event[mm/dd/yy]: 7 - L1 '-,)- 3 Time: 1 dC' 60 AP) Event Cleanup Completion [mm/dd/yy]: 7 - L/ - c)- 3 Time: / A// /n Have all residents on the affected block have been notified and invited? [ 4es ❑ No Please attach a copy of the door hanger or letter used to notify residents in addition to signature attachment. Number of households fronting the proposed street closure: Number of households represented by signatures on attached sheet: O Will this event have music (live or other)? El Yes L`'f No