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of BP�o City of South Bend Special Event Application <br />Neighborhood Event <br />o <br />• �' $25 application fee if filed 30 days or greater (up to 180 days) in advance of event. <br />• 1865 i <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 complet <br />N,>98�--�` q s <br />Event applications must be submitted more than 30 days in advance c r n Cy <br />be accented. <br />Section A - Anplicant Informati <br />Date of Application: 0 _ Z 3 Organization Nam <br />Applicant (Contact) Name: &V/ 0 CI'/ V A 7\ /- <br />Applicant (Contact) Phone: 71I - L to - (o? I Contact Email: _ <br />Address: S O Z L Sa,4f '�4 City/State/ZIP: S <br />Secondary Contact Name: Alex �,/a,,la,\ <br />Contact Phone: 2 `/O - 'PSE - O i d�O Contact Email G <br />Address: 5�Z L $ rlc S� City/State/ZIP: <br />• / / Section B - Event Information <br />Event Name: ��(r t'c^ trr S-Mh r i de4—'txpecteclAttendance: <br />Requested Street Closure: / W 0 It Spier- 4- <br />-From (Cross Street):/ f e<n In w A 14 I/C <br />To (Cross Street): Z r or w xi d 0l ', <br />Provide a brief description of the event: <br />Sco <br />Date of Event Setup [mm/dd/yy]: 7,/Iq/21Time: /� 3 0 n N <br />Begin Date of Event [mm/dd/yy]: Z 3 Time: CX) /Yl <br />End Date of Event [mm/dd/yy]: �'//5Z 3 Time: 00 O/K <br />Event Cleanup Completion [mm/dd/yy]: _ 7// Z 3 Time: g' W �, M <br />Have all residents on the affected block have been notified and invited? Kyes ❑ 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: Q <br />Number of households represented by signatures on attached sheet: <br />Will this event have music (live or other)? X'Yes ❑ No <br />