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City of <br />Peq ot <br />Lakes:_--z--- <br />HUTT <br />APR 0 S 2023 ID <br />By <br />SPECIAL EVENT PERMIT APPLICATION <br />SUBMIT <br />1. Today's Date: 4 ° 1. 2- © 2 3 <br />2. Applicant Name (Contact): P e 9 v o f hYs t3 r_ -rL-t Pv ,^ t- ah C C t j 6 <br />3. Applicant Address: P Q T3 o x 5 I P cl u c+ L�zs I -4 i A T(0 d-Tz. <br />4. Applicant Daytime Phone: 4 S -5 L 1- z `i 1 to Applicant Email: I vVf_4-ke f(y, t2j MOM kt'ys C 14m J • b <br />5. Event Coordinator: Phone # 216 5 Z 1- Z 49 to <br />6. Name of Event: C h z — y <br />7. Event Location: W,,46 s;ctt e j- p, <br />8. Description of planned activities including entertainment, music, amplified sound, food, and <br />beverage service to be held on the closed street: C (a s s; e how c rz�. t' i v r <br />fs�d {-�'G4 V`Gv�cla�c <br />9. Dates of Event: S44- _S-u,,t 3, 2oZ3 Starting Time: bAvvi Ending Time: 4Pm <br />10. Setup Time: L Nm Take Down Time: 3 P r^ <br />11. Request to Close City Street — Name and exact location of Street to be closed: <br />`NIA <br />12. Exact Dates and Hours that Street will be closed: N JA <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 />