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2. First Name
3. Last Name
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
12. Email Address
14. Organization/Neighborhood:
16. Event Name:
17. Event Date
    Event Date
19. Event Hours:
    Event Hours: Start Time

    —

    Event Hours: End Time
20. Event Location:
22. Set Up Start Time:
    Set Up Start Time:
23. Clean Up End Time:
    Clean Up End Time:
25. Event Description:
27. Road Closure Barriers & Signs:
    -- Select One --I will provide my own barriers & signage to mark the road closureI would like to borrow the City's barriers & signs to mark the road closure
29. Upload Event Diagram/Map Showing Road Closure:*
30. Block Party Signature Form:*
32. Electronic Signature Agreement

    By checking the "I agree" box below, the Applicant agrees and acknowledges that the Applicant does hereby agree, on behalf of itself and its successors and assigns, to indemnify, defend and hold the its officers, officials, agents, employees, boards, commissions, and volunteers free and harmless from and against any and all claims, demands, causes of action, damages, liabilities, costs of expenses (including the cost of attorney’s fees for defending any action brought against the City or any of its, officers, officials, agents, employees, boards, commissions, and volunteers), arising out of or in any manner relating to any form of loss, injury, or damage sustained by Applicant or any person as a result of the use for which the permit has been issued by City from the activity sponsored by such applicant or the use and occupation of city streets/facility/park premises.

    1. I agree.
34. Electronic Signature
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field