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Neighborhood Block Party Permit Application

2. • No permit fee required • Other fees may apply • Due 30 days prior to event

   • No permit fee required • Other fees may apply • Due 30 days prior to event

6. APPLICANT INFORMATION

8. First Name*

9. Last Name*

11. Company/Organziation

13. Address*

15. Address2

17. City*

18. State*

19. Zip*

21. Phone (Day) *

22. Phone (Evening)

24. Phone (Cell)

25. Phone (Fax)

27. Email*

31. EVENT INFORMATION

33. Name of Event (if any)

    You may include your neighborhood name if there is no name for your event.

35. Event set-up start time*
    Event set-up start time

    Event set-up start time

36. Event tear-down time:*
    Event tear-down time:

    Event tear-down time:

38. Event date*
    Event date

39. Event hours*
    Event hours Start Time

    —

    Event hours End Time

41. Estimated number of attendees*

43. Location of event and street closures requested *

    (attach map showing event and street closure locations)

45. Please provide detailed information on the event including:

47. • How will you close the streets? What will you use to block access?*

49. List all equipment and items that will be placed in the street.

    Remember to plan for emergency vehicle access

51. Any other details and information on the event:

53. Please mark all items that apply to your event and provide details.

    1. Concert or live music
    2. Cooking outdoors, grilling, barbecue
    3. Entertainers (clown, etc.)
    4. Exhibits or displays
    5. Fencing or scaffolding
    6. Tables and chairs

    1. Inflatable toys (bounce house, etc.)
    2. Public Address system or amplified sound
    3. Rally or Protest
    4. Tents
    5. Other

55. Additional documents

    Please upload additional documents here, such as a route or map, insurance documents, or community notification

57. PLEASE NOTE: SUBMISSION OF THIS FORM DOES NOT GUARANTEE APPROVAL OF YOUR EVENT.

59. The Permit Holder, its employees, agents, and volunteers (collectively “Permit Holder”) shall defend, indemnify, and hold the city, its officials, officers, employees, agents, and volunteers, harmless from and against any action, or claim for loss, liability, or damage, including claims for bodily injury or death, or damage to property arising out of or resulting from (a) Permit Holder’s use, in any manner, of city right-of-way or city-owned property for the permitted special event, and (b) Permit Holder’s non-observance or non-performance of any of the terms of Permit Holder’s special event permit. “City” means the City of Everett. I certify that: 1) the information provided on this application is true and correct; and 2) I am authorized by the Applicant to submit this application on the Applicant’s behalf.*
    -- Select One --I agreeI do not agree

61. E-signature*

62. Date signed*
    Date signed

64. Full Name*

65. Phone Number *

67. Organization Representing (if any)

Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit

* indicates a required field