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Small Special Event Permit Application

2. • Permit fee: $100 • Other fees may apply • Due 60 days prior to event • For fewer than 100 attendees

   • Permit fee: $100 • Other fees may apply • Due 60 days prior to event • For fewer than 100 attendees

6. APPLICANT INFORMATION

8. First Name*

9. Last Name*

11. Company/Organization

13. Address1*

15. City*

16. State*

17. Zip*

19. Phone (Day) *

20. Phone (Evening)

22. Phone (Cell)

23. Phone (Fax)

25. Email*

29. EVENT ORGANIZER INFORMATION

31. Company/Organization

33. Chief Officer Name

35. Address1

37. City

38. State

39. Zip

41. Phone (Day)

42. Phone (Evening)

44. Phone (Cell)

45. Phone (Fax)

47. Website

49. Email

53. EMERGENCY CONTACYS
    Please list two emergency contacts

    Please list two emergency contacts

55. Emergency Contact #1*

56. Emergency Contact Phone #*

58. Emergency Contact #2*

59. Emergency Contact Phone #*

63. EVENT INFORMATION

65. Name of Event*

67. Type and statement of the purpose of event: (i.e. Fundraiser, Concert, Company Picnic, Triathlon, etc.)*

69. Event set-up date/time*
    Event set-up date/time

    Event set-up date/time

70. Event tear down date/time*
    Event tear down date/time

    Event tear down date/time

72. Event date/ time (Day 1) *
    Event date/ time (Day 1)

    Event date/ time (Day 1)

73. Event date/time (Day 2)
    Event date/time (Day 2)

    Event date/time (Day 2)

74. Event date/time (Day 3)
    Event date/time (Day 3)

    Event date/time (Day 3)

76. Proposed Event Location (including proposed plan for set-up and tear down, and proposed locations of the assembly and production area)*

78. Facilities you plan to use

    1. Park
    2. Street
    3. Sidewalk
    4. Trail
    5. Parking lot
    6. Other

79. If other, please specify

81. Parks Outdoor/Special Use Permit
    Parks Outdoor/Special Use Permit

    If your event ALSO takes place in a city park, you must also apply for an outdoor/special user permit from the Parks Department.

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

    1. Alcohol
    2. Amplified sound
    3. Animals
    4. Bicycling
    5. Bleachers
    6. Boats
    7. Carnival Rides
    8. Caterer
    9. Company Picnic
    10. Concert/Live Music
    11. Cooking/barbecue

    1. Dance or Drama
    2. Drawing or Raffle
    3. Dunk tanks
    4. Electricity/Generator
    5. Entertainers (clowns etc.)
    6. Exhibits or Displays
    7. Fencing/scaffolding
    8. Festival
    9. Filming-video
    10. Filming-photography
    11. Fireworks

    1. Food
    2. Distribution/sales
    3. Helium Balloons
    4. Marching Bands
    5. Parade Floats
    6. Public Address (PA) System
    7. Rally/Protest
    8. Parking/shuttle
    9. Inflatable toys (i.e. bounce house)
    10. Race

    1. Run
    2. Satellite
    3. Sporting event
    4. Stage
    5. Tables/chairs
    6. Tents
    7. Theatre
    8. Vehicles
    9. Vendors
    10. Other

85. If other, please specify

87. Provide details for: the number and type of booths, tents, or other structures, he number of booths, tents, or other structures, the number of vendors selling goods or services and their location, the number of bands or other musical units, the nature of any equipment to be used and the nature and time of any activity at the event that will produce sounds or noises.

89. Will participants be charged a fee?

    1. Yes

    1. No

91. If Yes, please explain how much and purpose for collecting fee?

95. ATTENDANCE

97. Estimated total attendance *

98. Registered # of participants

99. Estimated # of vehicles

101. Registered # of animals

102. # of volunteers

103. # of staff

105. Description of the types of vehicles to be used and location of event staff and volunteers

107. Transportation and Parking Plans *

     Please provide the following on map(s) and a written explanation of each:  Detailed event site plan and layout/route (including a map and written narrative of the route).  Placement of signage, traffic control devices, barricades.  Location of traffic certified flaggers/monitor, and where you believe police officers are needed for traffic route/intersection control  Explain your parking and transportation plans.  Proposed alternate routes, sites or times, where applicable

109. Plans for security/crowd control, first aid/medical assistance and family reunification efforts*

111. Plans for portable toilets, garbage and recycling collection, sanitation, and clean-up*

113. Plans for notifying all agencies impacted by your event (i.e. residents, businesses, Everett Transit, Community Transit, Sound Transit, and DOT)*

115. Will food be distributed at your event? *

     1. Yes

     1. No

117. If yes, please explain plans (what type of food will be served? how will it be prepared? what food distribution/handling permits do you have?) If applicable, provide Health Permit # and Expiration Date

119. The anticipated quantity and types of any alcohol that will be served at the event, and a description of the location where alcohol will be served

121. Additional documents

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

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

125. 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

127. E-signature*

128. Date signed*
     Date signed

130. Full Name*

131. Phone Number*

133. Organization Representing *

Leave This Blank:


135. 1. Receive an email copy of this form.
136. Email address

     This field is not part of the form submission.

137. Submit

* indicates a required field