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City Of <br />Pequotit, <br />Lakes <br />SPECIAL EVENT PERMIT <br />1. Today's Date: <br />2. <br />3. <br />Applicant Name (Contact): <br />Applicant Address: <br />0 <br />12023 <br />APPLICA <br />at7 /J [> <br />OX <br />SUBMIT <br />4. Applicant Daytime Phone: 14czf-!9'_31 -�3 i Applicant Email: <br />5. Event Coordinator: rJC —all-A" !!"_ Phone # <br />6. Name of Event: 3 Al ufiL A r /L� GIB OuJN1?��/L� /�4r ND�z SOU <br />7. Event Location: CA,41 <br />S. Description of planned activities including entertainment, music, amplified sound, food, and <br />beverage service to be held on the closed street: <br />9. Dates of Event: o1 z ,itarting Time: `�6 r ��Ofl&Ending Time: <br />10. Setup Time: <br />Take Down Time: " <br />11. Request to Close City Street - Name and exact location of Street to be closed: <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 />