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• x+„T„ R, / City of South Bend Special Event Application <br />Neighborhood Event <br />$25 application fee if filed 30 days or greater (up to 180 days) in advance of event. <br />Please Bring 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 />Date of Application: <br />Applicant (Contact) <br />Applicant (Contact) <br />Address: kiYto City/State/ZIP: �i7✓/ // -��� <br />Secondary Contact Name: <br />Contact Phone: <br />Contact Email: <br />Address: City/State/ZIP: <br />Event Name: f / 17 <br />Requested Street Closure: <br />From (Cross Street): I�fl <br />To (Cross Street): cp / <br />Provide a brief description of the event: <br />Section B - Event Information ,'7 C <br />/� Expected Attendance: W-5 <br />Date of Event Setup [mm/dd/yyl: Time: '• <br />Begin Date of Event[mm/dd/yy]: ZO Time: (--)CJ'oki'l <br />End Date of Event Imm/dd/yyl oc-r?t 2-o23 Time: 9— F Q . C):ge%2 <br />Event Cleanup Completion [mm/dd/yy]: Time: ���• rl'1 <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 residents in addition to signature attachment. <br />Number of households fronting the proposed street closure: I <br />r <br />Number of households represented by signatures on attached sheet: <br />Will this event have music (live o other . yes 0 No <br />