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Fee Acknowledgment
Event Information
Sponsor Information
Road & Lane Closure (Barricades Request)
Road & Lane Closure (Licensed Contractors)
Compliance
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I hereby acknowledge that there is at least a minimum fee of $50.00 fee associated with the Special Event Permit Application and that I will send in payment (check/money order) after the application has been submitted. Acknowledge
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Effective immediately, all Special Event Permit Applications must be completed and turned into the Bureau of Codes office no less than thirty (30) days in advance or your event wil not be approved.
Type of Event: EventParadeStreet ClosureOther
This Event Is: PublicPrivate
Is the Event Indoor or Outdoor: IndoorOutdoor
Name of Event *
Start Date/Time *
End Date/Time *
Location *
Number of Attendees *
20%
Sponsor Name *
City as Co-Sponsor * YesNo
If yes, attach letter from mayor
Phone *
Alternate Phone
Email
First Name (must be present at event)*
Last Name (must be present at event)*
Address *
City *
State * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Zip *
Phone
Email *
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Barricade Service Requested: Placement of Barricades (Monday - Saturday Events) - $300.00Placement of Barricades (Sunday Events) - $500.00
Same-Day Removal of Barricades – Additional $150.00 YesNo * NO additional charge for the removal of barricades by event coordinator for next business day pick-up by Public Works
Start Date/Time
End Date/Time
Location of Work
Side Streets
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Length of closure Up to and including (7) days - $100.00Up to and including (14) days - $150.00Up to and including (30) days - $250.00Up to and including (45) days - $325.00Each additional day after (45) days - $100.00 per day
Description of Work
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Attach a required Certificate of Liability Insurance for the street closure with permit application.
I the above-listed applicant have thoroughly read and understand the conditions of this application. I understand that I must be present at the event and must be easily accessible at this event. I also understand that this application needs to be completed at least 30 days prior to the event. Applicant Signature:
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