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L J <br />• <br />City of South Bend Special Event Application <br />Neighborhood Event <br />j' $25 application fee if filed 30 days or greater (up to 180 days) in advance of event. <br />\ 1e76.5 ,y <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 - Aoplicant Information <br />Date of Application: D Organization Name: <br />Applicant(Contact)Name: O/' 15 <br />Applicant (Contact)Phone:.Uy jSz [- 10 Contact Email: dlowcL-4^r— io95otna L,Coni <br />Address: Y%1 � • l-l-A-NevAve-, City/State/ZIP:Sn).j4'I, (P-ti01, ZN <br />Secondary Contact Name: <br />Contact Phone:51 V 300 - 37 S� Contact Email: <br />Address: ND 2 F. / &4? City/State/ZIP: `5nol ►,r SE-)y oL Ilu V&g1-3 <br />Section B -Event Information <br />Event Name: P)iC4—h d6: �I fir } ��o Expected Attendance: <br />Requested Street <br />From (Cross Street): Fe'ell a 1j!5=1: , (ZIPVr r�ei1 L ST <br />To(CrossStreet): `rV &P"r-f--e-'I ST <br />Provide a brief description of the event: <br />I -uLl- a3 <br />Date of Event Setup [mm/dd/yy1:*g `� /- 3 Time: • O p✓✓t <br />Begin Date of Event [mm/dd/yy]: -7 -/-��_Time: '2) , 00 �Y►� <br />End Date of Event [mm/dd/yy]: ) - (./ r Time: Q - Do D rvi <br />Event Cleanup Completion[mm/dd/yy]: Time: S i �f7r- is OOP <br />Have all residents on the affected block have been notified and invited? Wes ❑ 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 o e ? 113 yes 0 No <br />