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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 />i <br />Please Bring 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 />Section A - Applicant Information <br />Date of Application: <br />Applicant (Contact) <br />Applicant (Contact) Phone: a 3- )0Contact Email: AS i G" jo 4 rj16'-1 z em <br />Address: [ I 0 /1/Af lei , S. J P alLIA City/State/ZIP: 5Du a1-4 <br />Secondary Contact Name: <br />v I <br />Contact Phone(679�c�o - Q -,i Contact Email: <br />Address: A n!� ALOE1P s'd.:e a" City/State/ZIP:- <br />Section B - Event Information <br />Event Name: �ij�� ((�� t ,PI G i Expected Attendance: <br />Requested Street Closure: Ali f0i 'r� ,rl -0- 6 (ylCA[-I (j-' /J"P/- i . n <br />From (Cross Street): <br />To (Cross Street): <br />Provide a brief description of the event: <br />Date of Event Setup [mm/dd/yy]: <br />Begin Date of Event [mm/dd/yy]: <br />End Date of Event [mm/dd/yy]: <br />Event Cleanup Completion [mm/dd/yy]: <br />Time: (0 �Q 0 I , j r / <br />Time: 0/) kn} ) <br />Time: <br />Time: <br />Have all residents on the affected block have been notified and invited? Wes ❑ 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 />- U <br />Number of households represented by signatures on attached sheet: <br />-O <br />Will this event have music (live or other)? Yes 0 No <br />4rnwfl <br />