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City of <br /> [1 � C � SUBMIT <br /> Pequ SEP 19 2022 <br /> Lakes: - g <br /> SPECIAL EVENT PERMIT APPLICATION <br /> 1. Today's Date: 91"/&- -2-Z• <br /> 2. Applicant Name(Contact): Af/2/ 7/z * i� �/�/ ��. 49l1 P////77` <br /> 3. Applicant Address: ,,, ,e96))5 ,9-/ 6q.,04/ 1.A.4.03- / ,,5-hc'7,0) <br /> 4. Applicant Daytime Phone:d/(5-4 4 -60—Applicant Email:///,/ - /`i <br /> 5. Event Coordinator: Kiln Z. Phone# <br /> 6. Name of Event: , ' ,061.) /7 .[J"/7 7 <br /> 7. Event Location:hljdO/ X7',/, sbd5i 2' - 1047//, 7 //5/:d-lf <br /> 8. Description of planned activities including entertainment,music, amplified sound, food, and <br /> beverage service to be held on the closed street:Jif 4,, mix p,0/-74n <br /> /-<S V a/i%4`,S <br /> 9. Dates of Event: / oe9/Z Z Starting Time: /0 Ending Time: /cc <br /> 10. Setup Time: � Take Down Time: / ,fr,am <br /> 11. Request to Close City Street—Name and exact location of Street to be closed: ,tie) <br /> 12. Exact Dates and Hours that Street will be closed: <br /> 13. Site Clean-Up—Removal of all equipment and clean-up of the area must be completed by the <br /> event participants <br /> S:Wdministration\Licenses\Special Event Permits\Special Event Application.doc <br />