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• <br />• <br />l ., City of South Bend Special Event Application <br />=—BED; <br />Neighborhood Event <br />LL' <br />' A4 $25 application fee if filed 30 days or greater (up to 180 days) in advance of event. <br />iCu�s <br />Please Bring Comoleted 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 - Applicant Information <br />Date of Application: 9-5 /n;t'3CYcV-) Organization Name:./y,.i �JD;A 'S eQ 144rl-) <br />Applicant (Contact) Name: G� IVN K n .c"O <br />Applicant (Contact) Phone:S71f 288o(8dr3 Contact Email: (A]t/i!i b-Sa=- C Yn M,W!&ki1,zm Corn <br />Address: S(Z C• +.lud City/State/ZIP: ni6(o lJ <br />Secondary Contact Name: (M-++i >G n� <br />Contact Phone: V)(4 Z8Vk- gRR3 Contact Email: (Zcan f . jr)Q j')Cs r/af'KiQ Sff an.r CoM <br />Address: 3;s/7 e, 5e- + %eN ;�lu✓ City/State/ZIP: 2e.) ;N <br />EventName:35t oryn;u fl"Mt'A jj - Oft heoExpectedAttendance: Ion- Zoo 4r� f <br />Pe <br />Requested <br />C' Is <br />Requested Street Closure: 4rvw—A e-r <br />From (Cross <br />To (Cross Sti <br />Provide a brief description of the event: <br />Date of Event Setup[mm/dd/yy]: /01Z `I� Z3 Time: /2 00 n.r, <br />Begin Date of Event [mm/dd/yy]: Zo 2 Time: DO Q,1-7 <br />End Date of Event [mm/dd/yy]: /V /(/ Q Time: 7 = 00 p y, <br />Event Cleanup Completion [mm/dd/yy]: /0 �/ 6� T3 Time: ap 2 n1 <br />Have all residents on the affected block have been notified and invited? _Zyss ❑ 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 frontingthe proposed street closure: ���I�S;/le.S.fcs;/Ie.SJcs <br />Number of households represented by signatures on attached sheet: l Z <br />Will this event have music (live or other)? _QYes 0 No <br />