Application for Special Events by STLCOGOV

Special Event Permit Application

PLEASE PRINT WITH BLACK INK – COMPLETE ALLSECTIONS AND SIGN APPLICATION

SECTION

HAVE

APPLICANT NAME (Print):

APPLICANT ADDRESS:

SPONSORING

SPONSORING ORGANIZATION:

PARTICIPANTS/VENDERS;

MANAGER

ESTIMATED PARTICIPANTS/WORKERS:

EVENT NAME: EVENT DESCRIPTION: EVENT TYPE □ Athletic/Recreation □ Concert/Performance □ Sales Event □ Exhibits/Arts/Crafts □ Church or Company Picnic □ Circus □ Festivals/Celebration □ Fund Raiser □ Fair/Carnival □ Parade/Run/Walk □ Subdivision Block Party □ Other

1 – EVENT GENERAL INFORMATION LOCATION OF EVENT:

ANNUAL

YOU HAD THIS EVENT BEFORE: □ Yes □ No

EVENT: □ Yes □ No

DATE OF

EMAIL:

APPLICATION: PHONE #: CELL #: FAX #:

PHONE #:

ORGANIZATION: PERSON IN CHARGE:

CELL #: PERSON IN CHARGE ADDRESS:

□ NOT-FOR-PROFIT (NFP) □ FOR-PROFIT

(FP)

□ NOT-FOR-PROFIT (NFP) □ FOR-PROFIT (FP) □ BOTH (NFP & FP)

SET

TAKE DOWN DATE(S)/TIME(S):

ON-SITE DAY OF EVENT: CELL #:

UP DATE(S)/TIME(S):

/ THROUGH

pm): Sun am/pm to am/pm Mon am/pm to am/pm Tues am/pm to am/pm Wed am/pm to am/pm Thurs am/pm to am/pm Fri am/pm to am/pm Sat am/pm to am/pm

REQUESTED DATE(S) OF OPERATION: /

_/ / HOURS OF OPERATION (indicate hours and circle am or

ESTIMATED

□

□ No TYPE: □ Signs □ Newspaper □ Radio □ Television □ Other:

ATTENDANCE: ADVERTISING:

Yes

(Specify fee amounts)

ADMISSION FEE: _________ PARKING FEE: ____________

DONATION:

OTHER FEES (EXPLAIN):

ESTIMATED RECEIPTS: DISTRIBUTION OF RECEIPTS:

INSURED PERSON / ORGANIZATION: □ Applicant □ Sponsoring Organization □ Property Owner

INSURANCE COMPANY:

SECTION 2 – EVENTS ON PRIVATE PROPERTY

(Includes events staged from or ending on private property such as parades, runs/walks, etc or events viewed from private property such as fireworks displays)

PROPERTY OWNER:

If multiple property owners, please attach additional sheets

OWNER or OWNER’S AGENT AUTHORIZING EVENT:

OWNER’S ADDRESS:

PHONE #:

SECTION 3 – EVENTS REQUIRING TRAFFIC CONTROL AND/OR COUNTY ROADWAY CLOSURES

EVENT WILL REQUIRE TRAFFIC CONTROL: □ Yes □ No

EVENT WILL REQUIRE COUNTY ROADWAY CLOSURES: □ Yes □ No (If answered no to both of the above, continue to SECTION 4)

PURPOSE OF TRAFFIC CONTROL:

TYPE:

NAMES OF ROADWAYS IMPACTED:

DATE(S) & TIME(S) CONTROL REQUIRED:

CONTROL PROVIDED BY:

NAME OF ROADWAY(S) TO BE CLOSED:

PURPOSE OF ROADWAY CLOSURE:

BOUNDARIES OF CLOSURE:

DATE(S) & TIME(S) OF CLOSURE:

SECTION 4 – EVENT ACTIVITIES (check and complete all that apply)

FOOD CONCESSIONS & BEVERAGES:

Food concessions and/or beverages will be provided: □ Yes □ No

Type of food: □ Meat □ Fish □ Snacks □ Desserts □ Other

Dispensed: □ Pre-Packaged □ Wrapped □ Plate □ Self Service □ Other:

Off-site food preparation □ Yes, □ No If yes, by whom: _______________ Where: __________________

Cooking on site □ Yes, □ No If yes, specify method: □ Gas □ Electric □ Charcoal □ Other:

Company/Vendor providing:

If multiple Companies/Vendors, please attach additional sheets

Phone #:

Type beverages: □ Beer □ Other Alcohol □ Soda □ Other Non-Alcohol

Dispensed: □ Bottled □ Cans □ Machine/Tap

Company/Vendor providing: Phone #:

If multiple Companies/Vendors, please attach additional sheets

AMUSEMENT RIDES/DEVICES INCLUDING INFLATABLE’S:

Type rides/devices: □ Amusement □ Inflatable(’s) □ Other:

Company providing: Phone #:

If multiple Companies/Vendors, please attach additional sheets

FIREWORKS/PYROTECHNICS:

Type of Display: , Hours: pm to pm, Discharge Location: Company providing: Phone #:

ENTERTAINMENT and/or NOISE PRODUCING ACTIVITIES:

Type: □ Live Band □ Music □ DJ □ Other (Please describe): Location: □ Indoor □ Outdoor, Entertainment/Activity Hours: am/pm until am/pm

OTHER EVENT ACTIVITIES (Please describe):

SECTION 5 – EVENT SUPPORT FACILITIES & SERVICES (check and complete all that apply)

PARKING: □ On-Site □ Off-Site Approximate # of Parking Spaces:

PARKING CONTROL: □ Sponsoring Organization □ Property Owner □ Private Security/Off-Duty Police

□ Other (describe):

ELECTRICAL POWER SOURCE: □ Existing Service □ Existing Site Power □Temporary Service/Power

□ Generator □ Diesel □ Gasoline Other (describe):

SANITARY FACILITIES:

□ Public Rest Rooms, # of Men’s Facilities: _, # of Women’s Facilities: _, # of Unisex Facilities: Location(s): □

WASTE HANDLING/DISPOSAL:

Toilets, # of units Company Providing Portable Toilets: Location(s): SPECTATOR AREA: □ Fenced □ Roped Seating: □ Yes □ No ; □ Permanent □ Temporary ACTIVITY AREA: □ Fenced □ Roped □ Posted ; □ Booths □ Exhibits □ Displays □ Other Enclosures

□ Canopies, # , size sq ft □ Tents, # , size sq ft □ Stage(s), # size sq.ft. □ Other (describe): , size sq.ft. For

Portable

TEMPORARY STRUCTURES:

multiple temporary structures of the same type please attach a separate sheet listing each structure and size Indicate locations of all temporary structures on the site plan

□ Trash

□ Dumpsters, # (indicate location

□ Fire

Cans, #

on site plan) FIRE PROTECTION: □ Fire District/Department

Extinguisher(s), #

District/Department

FIRST AID PROVIDED BY: □ Sponsoring Organization, □ Fire

□ Trained Medical/EMT, □ Not Provided for this Event, □ Other:

□ Banner,

□ Other:

SIGNS: □ Directional, # (indicate location of signs on the site plan)

Type

SECURITY: □ Sponsoring Organization □ Police □ Private Security/Off-Duty Police □ Other:

CLEANUP: □ Sponsoring Organization □ Associate Volunteer Organization □ Other

OTHER SUPPORT FACILITIES & SERVICES: (Please describe):

SECTION 6 – SITE PLAN / ROUTE MAP

ATTACH / PROVIDE A SITE PLAN OF THE EVENT LOCATION. INCLUDE ON THE SITE PLAN THE LAYOUT OF ALL PROPOSED ACTIVITIES, LOCATIONS OF BOTH PERMANENT AND TEMPORARY STRUCTURES, LOCATIONS OF SUPPORT FACILITIES, PARKING AREA, ETC INCLUDE DIMENSIONS. ALSO INCLUDE A ROUTE MAP AND PLAN OF THE STAGING AREAS IF THE EVENT IS A PARADE, BIKE RACE, RUN, WALK OR SIMILAR TYPE EVENT.

(Note: If the site plan and/or route map is larger than 11x17 provide 6 copies with your application)

SECTION 7 – APPLICANT ACKNOWLEDGEMENT & SIGNATURE

I hereby apply for a Special Event Permit to conduct the activity described in this Application. I further understand that any permit which may be issued based on the information contained within this Application is subject to revocation should the information provided herein not be accurate or complete. I acknowledge that if I am not the owner of the property, or properties, on which the special event is to be held, I am responsible for obtaining permission from the owner of the property, or properties, on which the special event referenced in this Application is to be held prior to holding such event. I understand that if a Special Event Permit is issued, it is the sole responsibility of the holder of this Permit to consent, and to obtain any licenses, consents, and/or permissions from all persons or entities holding an ownership interest in the property, or properties, on which the event is to be held, to allow entry onto the property by St Louis County employees to inspect prior to, and/or during, and/or after the event

I further acknowledge and understand that the Special Event Permit, if issued, is not an all encompassing permit and that separate individual permits or licenses are required for certain kinds of event related activities, amusements, and/or for support facilities, as well as, for any temporary advertising signs.

APPLICANT’S SIGNATURE: Date: / /

(Below For Public Works Office Use Only)

PERMIT #: FEE $ LOCATOR NUMBER:

DATE APPROVED: CODE

C: ST LOUIS COUNTY DEPARTMENTS OF HEALTH, TRANSPORTATION, POLICE, REVENUE-LICENSING

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ENFORCEMENT DIVISION

MANAGER