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LOCAL AUTHORIZATION FOR TEMPORARY BEER &WINE PERMIT APPLICATION <br />•Cmlrf INSTRUCTIONS: 1 Appacant mug complete, a/l requested infomshon <br />2 Please type orpnrx dearry, <br />3. ObtaintheregWfedMMMMtydearancesignaluresandupbadWshdraonlinetemporarye MBPALcafnn <br />NOTE. THIS FORM IS ONLY TO BE USED WI I H ONLINE APPLICATION Vislt https limyecanse in gov/eGov/MLI html to subm t the online aPiX= m. <br />. —1 <br />STEP 1. GENERAL INFORMATION <br />Name of applkwt applying for permit (owneation, dub, corponaaon m&wdual -such as XyZ 123 Inc) <br />rass W app Inur.roerand eel. ,dale. and Pcoda) <br />Email address <br />Pnn: name pars m ng app iwtidn <br />Fax raleEer <br />! 1 <br />cY motes, to ne num r <br />Pnnl@d name d fAmaG. pef5en 0(event <br />mElgency cOn1aC11C Epnprq rlYmaer <br />1711eulse U <br />STEP 2- EVENT INFORMATION <br />Ile <br />Beginning day (Monday, Tuesday. etc) Beg,nnii dale (mach, day, yesrl Endnp rlW/ (IbrrddY. <br />Tffesday. etc) date date (month, day, year) E <br />limit, of event <br />Start time 2.00 ✓ M Endtime <br />9.� AM ✓ PM <br />Type a descnphon a event <br />Parish Festival <br />Exact address of event (ivanba aw unw. city. state. and DPco*) <br />735 W Calvert <br />- <br />STEP 1 FLOORPLAN <br />-7 <br />�NURGti [ s� ,--7 <br />AA <br />GYM <br />�wR d- w10& j <br />E <br />STEP 4. APPLICANT VERIACA WIN <br />TM below slpaedopppcafd allinv aWW fio permldes Of pegary fief the bffavwMbn coefelnedin f. 6wY 6wawdacMl� <br />IgreuNe of applxant- <br />DWastpltad (nail day. Yeed <br />M. o7V"--4 z�rr� <br />6-la- 1pz5 <br />- <br />STEP S. COMMUNITY CLEARANCE _ <br />1 Sgnel OI ry,efGhNorMaMd.111behd <br />, <br />sWN^doPoh (Rpr1M.ay,yearl <br />2 Signacvr of the mays the event rs MMm ort Wayne) <br />D f .day Year) <br />��] trash <br />