Block Party Form

It contains RadEditor's Modes/views (HTML, Design and Preview), Statistics and Resizer
Editor Mode buttons	Statistics module	Editor resizer
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Event Details
Event Name:
Application Date: Select a date ...	Applicant Name:
Organization Name:	Indicate if Organization is Profit or Non Profit:
Address Line 1:	Address Line 2:
City:	State:
Zip Code:	Phone Number:
Alternate Number:	Email Address:
Event Start Date: Select a date and time ...	Event End Date: Select a date and time ...
Estimated Attendance:	Estimated Vehicles:
Will Alcohol Be Sold, Served or Consumed?:	Will Food, Goods, or Services be Sold or distributed?:
Is there an Admission Fee?:	If Yes, how much?:
Will Outdoor Musical Entertainment Be Provided?:	If Yes, what type?:
Is the Event Being Promoted to the Public?:	If Yes, How is the Event Being Promoted?:
I certify that the above information, to the best of my knowledge is correct. I also, certify and understand that if I misrepresent the size and scope of event, or obtain this permit fraudulently, future permits will be denied.

It contains RadEditor's Modes/views (HTML, Design and Preview), Statistics and Resizer
Editor Mode buttons	Statistics module	Editor resizer
Design HTML Preview

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Date Submitted:

Select a date

...

Event Start Date:

Select a date

...

Event End Date:

Select a date

...

Name of Organization/Event Sponsor:

Applicant/Contact Name:

Contact Phone:

Conatct Email Address:

Contact Fax:

Title of Event:

Event Duration:

If Road Closure(s) involved:Closure Start Time (incl. Set up/Barricades):

Select a date and time

...

Closure End Time (Barricades removed):

Select a date and time

...

Please describe road(s) to be closed and/ attach map (required):
“See Attached Map” is not acceptable. Please list each road that will be closed (with limits from – to) and the duration of the closure.DO NOT USE THIS FORM FOR EVENTS THAT WILL CLOSE STATE ROAD(S) AND/OR REQUIRE LOCKDOWN OF THE MAIN STREET OR ORTEGA DRAWSPAN

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Attach Map Here:

Click here to attach a file

Please describe detour route and attach map(if applicable):

Type a value

Attach Detour Map here:

Click here to attach a file

Is the Event in a Residential Neighborhood?:
(If the Event is in a Residential Neighborhood written consent of atleast 70% of occupants of property in the neighborhood is needed)

Please attach the written consent here:

Click here to attach a file

Any Special Conditions?:

Describe Special Conditions:

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Insurance Requirements

It contains RadEditor's Modes/views (HTML, Design and Preview), Statistics and Resizer
Editor Mode buttons	Statistics module	Editor resizer
Design HTML Preview

Type a value

Hold Harmless and Indemnification Agreement

It contains RadEditor's Modes/views (HTML, Design and Preview), Statistics and Resizer
Editor Mode buttons	Statistics module	Editor resizer
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Type a value

Marking Of Pavement/Clean-up For Special Event

It contains RadEditor's Modes/views (HTML, Design and Preview), Statistics and Resizer
Editor Mode buttons	Statistics module	Editor resizer
Design HTML Preview

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Certification
I certify that the above information, to the best of my knowledge is correct. I also, certify and understand that if I misrepresent the size and scope of event, or obtain this permit fraudulently, future permits will be denied.

Agree To All

Event Details
Event Name:
Application Date: Select a date ...	Applicant Name/Organization:
Organization Name	Indicate if Organization is Profit or Non Profit:
Address Line 1:	Address Line 2
City:	State:
Zip Code:	Phone Number:
Alternate Number:	Email Address:
Event Start Date Select a date and time ...	Event End Date Select a date and time ...
Estimated Attendance:	Estimated Vehicles:
Is there an Admission Fee?:	If Yes, how much?:
Will Outdoor Musical Entertainment Be Provided?:	If Yes, what type?:
Will Alcohol Be Sold, Served or Consumed?:	Will Food, Goods, or Services be Sold or distributed?:
Is the Event Being Promoted to the Public?:	How is Event Being Promoted?:
I certify that the above information, to the best of my knowledge is correct. I also, certify and understand that if I misrepresent the size and scope of event, or obtain this permit fraudulently, future permits will be denied.

It contains RadEditor's Modes/views (HTML, Design and Preview), Statistics and Resizer
Editor Mode buttons	Statistics module	Editor resizer
Design HTML Preview

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DATE SUBMITTED:

Select a date

...

EVENT START DATE:

Select a date

...

EVENT END DATE:

Select a date

...

NAME OF ORGANIZATION/EVENT SPONSOR:

APPLICANT/CONTACT NAME:

CONTACT PHONE:

CONTACT E-MAIL ADDRESS:

CONTACT FAX:

TITLE OF EVENT:

EVENT DURATION:

IF ROAD CLOSURE(S) INVOLVED:
CLOSURE START TIME (INCL. SET UP/BARRICADES):

Select a date and time

...

CLOSURE END TIME (BARRICADES REMOVED):

Select a date and time

...

PLEASE DESCRIBE ROAD(S) TO BE CLOSED AND/ ATTACH MAP (REQUIRED): “See Attached Map” is not acceptable. Please list each road that will be closed (with limits from – to) and the duration of the closure.DO NOT USE THIS FORM FOR EVENTS THAT WILL CLOSE STATE ROAD(S) AND/OR REQUIRE LOCKDOWN OF THE MAIN STREET OR ORTEGA DRAWSPAN

Type a value

ATTACH MAP HERE:

Click here to attach a file

PLEASE DESCRIBE DETOUR ROUTE AND ATTACH MAP:

Type a value

ATTACH DETOUR MAP HERE:

Click here to attach a file

IS THE EVENT IN A RESIDENTIAL NEIGHBORHOOD:
(If the Event is in a Residential Neighborhood written consent of atleast 70% of occupants of property in the neighborhood is needed)

Consent Attachment

Click here to attach a file

ANY SPECIAL CONDITIONS?:

DESCRIBE SPECIAL CONDITIONS:

Type a value

Comments Date

Comments By

Department

Comments

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