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1 <br /> <br /> <br />Special Event Permit Application <br /> <br />I. Title and Brief Description of Event <br /> <br />______________________________________________________________________________ <br /> <br />______________________________________________________________________________ <br />II. Applicant Information <br />The applicant is responsible for answering all questions, including inquiries from media and <br />citizens. <br />Applicant:___________________________________ Title:_____________________________ <br />Address:_______________________________________________________________________ <br />Business/Organization:___________________________________________________________ <br />Daytime Phone:____________ Mobile Phone:_____________ Emergency Phone:____________ <br />III. Event Timetable <br />A. Requested day and date:___________________________________________________ <br />B. Requested Hours of Operation, from __________a.m./p.m. to ____________a.m./p.m. <br />C. Set up beginning day and date____________________, time ______________a.m./p.m. <br />D. Dismantle by day and date_______________________, time ______________a.m./p.m. <br />E. Anticipated number of participants: ______________; and spectators: ______________ <br /> <br />IV. Insurance <br />Attach to this application either an insurance policy or a certificate of insurance including the policy <br />number and showing liability amounts. The policy must state that any outside area to be used for <br />an event is covered. The policy must also show evidence that the requested event is not excluded <br />from insurance liability. <br />