Special Event - East Washington Block Party - July 29

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T City of South Bend Special Event Application d Neighborhood Event $25 application fee if filed 30 days or greater (up to 180 days) in advance of event. Please Brine Comoleted Aoolication 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. 2 Section A - Applicant Information \ Date of Appl ication: 25 2 J Organization Name: i Applicant (Contact) Name: pCA (0121 Applicant (Contact) Phone: 574' 0J55 -J i� Contact Email: I C�y-YIam a Gh{ eehDtma 1 1 ' cok Address: o N, Swu sId.P Ave City/State/ZIP: Dw rt Secondary Contact Name: Contact Phone: Contact Email: �� , I Address: City/State/ZIP: SQo PXrJj )N 4&17 Section B - Event Information �7 Event Name : Q S rr I Bloc!- Pa Exxppected Attendance: I S Requested Street Closure: LIQst' l I h n S , From (Cross Street): J of ry b To (Cross Street): Uy h n ti S I,e Provide a brief description of the event: I�ei�Ohl�Vhood Bloch Pat Date of Event Setup [mm/dd/yy]: ZI 75 Time: I 0 AM Begin Date of Event[mm/dd/yy]: 22 Time: End Date of Event [mm/dd/yy]: 23 Time: QI, Event Cleanup Completion[mm/dd/yy]: Zq Z3 Time: Have all residents on the affected block have been notified and invited? Yes ❑ 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: 10 Number of households represented by signatures on attached sheet: -1 W -r" IN (�' IS03 Wilshirli M wol" C Will this event have music (live or other)? ❑avlsww 'kt dw wo -PuhYes No u GtiL Kq� Mille le drlve^ wavj Is on Senn yid. So not a4¢cc.kd b'1 clo we