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m : j; -_" City of South Bend Special Event Application <br />City and Regional Event <br />'� 5, rfnrt ill <br />$50 application fee if filed 60 days or greater (up to 360 days) in advance of event <br />$100 expedited application fee if filed 30-59 days in advance of event <br />lea a Bring Completed Appli ation and Pa me 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. City and Regional Special <br />Event applications must be submitted more than 30days in advance of the event date or the application will not <br />be accepted. <br />/ I Section A -- Applicant Information <br />Date of Application: �/1L4 /ZdL'5 Organization Name: LK 10d-11 Gib f IflL'97•-fcl �! Ic <br />Applicant (Contact) Name:_ <br />Applicant (Contact) Phone: Z (0o q,1Z - I tf elf Contact Email: h 1n-,d-e.g C-a 6 A <br />Address: -753) W )V., City/State/ZIP: U��, <br />e ANe-- e Awch <br />List any pFafes+re"e1 event organizer, event service provider or that is authorized to work <br />on your behalf to plan, produce and/or manage your event. <br />Organization Name: 11�,5 ;i ir,'s Contact Name: <br />Contact Phone: <br />S - 3 q <br />Contact Email:, <br />5C1 e e k,, - cI <br />c- 0 me, d -f 6 rr,) jr3 <br />jA' 'o <br />Address: / -7 6) Y i7j'0 , <br />City/State/ZIP: <br />JG'v �A <br />j3r ,J )Q <br />q1w, 13 <br />Section B - Event of rm ti n <br />Event Name: C n r a14 s CA A ri s fir' 1240 C f55,c-Event Type: (Festival, Race, Parade, Other): -6 <br />Event Classification: Non -Profit* ❑ For -Profit <br />❑ City (Civic) Sponsored Other (If Other, please describe): /y.i t - a'2 o u e. <br />*The Special Events Committee may request proof of non-profit status. <br />Provide a brief description and timeline of event (Note: A detailed map plan is required in Section H of this <br />application. The description should be a summary overview.) <br />Date of Event Setup [mm/dd/yy <br />Begin Date of Event [mm/dd/yyl: <br />End Date of Event [mm/dd/yyl: L 1 ZZ /( Time: <br />Event Cleanup Completion [mm/dd/yy): L' h ZZ / //Z s Time: <br />Time: Z ` c' �5 n f- , <br />Total anticipated attendance: <br />SVr (P l2Z/2S <br />4° J Z7 l zs <br />Z00 <br />Time: <br />The proposed event will require the cleMrrg-of: [Streets [Sidewalks <br />U S�' <br />3'.cto Pm <br />Z40 d p " <br />Lf ;t'S pry <br />