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City of South Bend Special Event Application <br />0 x Neighborhood Event <br />-� = $25 application fee if filed 30 days or greater (up to 180 days) in advance of event. <br />iers _. <br />Please Bring Completed Application and Payment to: <br />Public Works Service Center, 731 S. Lafayette Blvd., South Bend, IN <br />• <br />40 <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 Date of Application:�r� Organization Name: (574?U l1l)fiA Musej) Y- <br />Applicant (Contact) <br />e. <br />Applicant (Contact) Phone: cJr -97/� Contact Email: o t, OI�� <br />Address: aW i r 1 City/State/ZIP: <br />Secondary Contact Name { 6"1a,L <br />Contact Phone: _Z35—%/TContact Email: <br />n' Q, <br />Address: aO� (,{1�p/ n- ryE City/State/ZIP: SOLI% <br />Event Name: <br />Requested Sti <br />From (Cross Street): Law -Pt ;t, <br />To (Cross Street): --iCAP--p I ,L- �- . <br />Provide a brief description of the event: AK i n v;+,aiori - O Vih� C," S4vW, e)c b i+e t. I tt. +f ie- <br />KIS•kovie, ohvev V405iC'n aY �7ei� c at ilk 36vwCase l 2s if �(yr;'ves <br />}�asi . 6leaehE�s oh V WaS�tIN j�vV� t (7tl�K. ��1 iVC� ( [� llL. -T Fke <br />will 6- so/ci at .2 errtt a . FultrEst prose" to behecFb big -5hap- 'ev A/At / <br />Nltise+t(�'. "7k;,5 will tke. zixik Lear W , ka. e. -tkis et/etrt-. <br />Date of Event Setup[mm/dd/yy]: <br />3 <br />Oct Time: Sa/iL. <br />Begin Date of Event [mm/dd/yy]:-/u/ <br />l3 <br />ZO' Time: /O a/yi <br />End Date of Event[mm/dd/yy]: <br />Ju <br />l3 <br />Oo Time: <br />Event Cleanup Completion [mm/dd/yy]L. k3Time: Co pl - <br />Have all residents on the affected block have been notified and invited? &�e ❑ 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: eZ <br />Number of households represented by signatures <br />on attached sheet: <br />Will this event have music (live or other)? ['Yes ❑ No <br />