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• <br />• <br />u <br />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 />,asa <br />Please Brine 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 />FT_riiR7i M-TS7111-1M, 111 • ,t7Tifi31?i1 <br />Organization Name: <br />Applicant (Contact)Phone: (s74)S-7 ass Contact Email: <br />Address: '15 3 S • 3e nd i�( d JT, City/State2lP: _ <br />Secondary Contact Name: <br />Contact Phone: <br />Address: <br />Email: <br />-i •, = M u Ml <br />Event Name; 6'�( - &1'1� I�tA ��i Expected Attendance: -P&M <br />Requested Street Closure: yLl�►con SA, <br />From (Cross Street): ;Pi A k- 17 t2 <br />To (Cross Street): <br />Provide a brief description <br />Date of Event Setup [mm/dd/yy]: Time: t <br />Begin Date of Event [mm/dd/yy]: LIJZ-S _Time: <br />End Date of Event [mm/dd/yy]: (7/j 7 Q�_Time: nr 700-Ae PA <br />Event Cleanup Completion [mm/dd/yy]: <br />Have all residents on the affected block have been notified and invited? <br />FYes ❑ 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)? Yes 0 No <br />