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'WTngi i City of South Bend Special Event Application <br />Z. <br />• = Neighborhood Event <br />k ' $25 application fee if filed 30 days or greater (up to 180 days) in advance of event <br />Pose Brine Completed Application and Pavment 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: Organization Name:Q� <br />Applicant(Contact)Name:, ailelasa <br />Applicant(Contact)Phone:W-MV-1%oContact Email: �[�egDi5l15bOt'171 <br />Address: rGtNdl S� City/State/ZIP: _��� /t <br />Secondary Contact Name: <br />Contact Phone: _- Contact Email: <br />Address: City/State/ZIP: <br />• I Section B - Event Information <br />Event Name: �.2Si-dam DI Tuld &q Expected Attendance: <br />Requested Street Closure: <br />From (Cross Street): (a <br />To (Cross Street): RyttL <br />Provide a brief description of the event: <br />".in a 1A1 a are h juid ciaq +/ -Ik lash- dat� s Aw I, an <br />6U2 walId IIKC 4-6 hA4 aalu44 ovfSCha>► as in our <br />C44tA pWklnj b i-j AtcA a avoSS _0m WSCA 1. <br />Date of Event Setup [mm/dd/yy]: Time: _ p, OOarr <br />Begin Date of Event [mm/dd/yy]: (# _+,X0j4 Time: _ o-'3f1� p i✓1 <br />End Date of Event [mm/dd/yy]: (f _q =q Time: �• V��/Yl <br />Event Cleanup Completion [mm/dd/yy]: <br />Have all residents on the affected block have been notified and invited? ® Yes ❑ 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 other)? 0 Yes ❑ No <br />