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City of 14�1 <br />Pequotl <br />akes:_::��. <br />I SUBMIT <br />MAR 17 2023 01 <br />SPECIAL EVENT PERMIT APPLICATION <br />1. Today's Date: —.5 <br />2. <br />le d3 �, /�z <br />Applicant Name (Contact): <br />3. Applicant Address: <br />4. Applicant Daytime Phone:,::V6SWr�Applicant Email: <br />5. Event Coordinator: ,�(�,hi �� �P/�t ��" Phone #�� <br />6. Name of Event: <br />7. Event Location: <br />8. Description of planned activities including entertainment, music, amplified s und, food, and <br />beverage service to be held on the closed street: ' � �/ 14, lt� <br />9. Dates of Event: ,�� O` �'�� Starting Time: nding Time: Z ( 41 <br />10. Setup Time: __q Take Down Time: U <br />11. Request to Close City Street — Name and exact location of Street to be closed: AleOl <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:\Administration\Licenses\Special Event Permits\Special Event Application.doc <br />