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<br />,,::!) <br /> <br />~cgWJW <br /> <br />-'u~/ <br /> <br />City of <br />Elk --- <br />Ri r-' . <br />1. ~ed--el'l\ck iJeJ1nJ~ !J1t"Ccr7 <br />(Full name of applicant including first, middle, last, and~aiden) <br />2.1J1(?('~~, fJh(~;l/~r7b*"FjJ"t!~ ~~) 7~5 '-It:fl 0'101 <br />(ApplicaKt's business name) (Applicant's business phone number) <br />6,)/ fJ1;;; fJ1 s::/ .Elk Rt 'v -e r <br />(Applicant's business address) <br />4. ,V(ju.rYJ t-du..J >1 P (Ie tf/v e r <br />(Name of business where event will be located) <br />c5/Jll1e <br />(Address where event will be located <br /> <br />.--..-- <br /> <br /> <br />CITYOF'ELKRIV.ER <br />SPECIAL EVENT FORM <br /> <br />3. <br /> <br />5. <br /> <br /> <br />6. <br /> <br />(Dates e ent will take place) <br />7. PUblic/Private~ Prope~(circle one) <br />8. Written permission of property owner attached DYes ~ No <br /> <br />9. Registered with State of :Minnesota D Yes <br />*10. Certificate ofInsurance attached DYes <br /> <br />)ZJ No <br />~No <br /> <br />11. Contact Planning Department for information regarding temporary signs. <br /> <br />12. If applicable, contact the :Minnesota Department of Health regarding itinerant food license(s) at <br />651-201-4505 <br /> <br />* A certificate of insurance indicating that the applicant has a policy of public liability insurance in the amount of <br />$1,000,000 must be provided to the City of Elk River 10 days prior to the event. <br /> <br />I certify that the answers given herein are true and complete to the best of my knowledge and I have not omitted <br />any information. I further nnderst=d that false, mislea~.. e~ m, forman,' on, . in my application form may <br />disqualify me from liolding this event ff) 1JJ~ <br /> <br />Date: l~ ;?~ ,;0-oh Signed: , · <br />(/ <br /> <br />This form is to be used for carnivals, Chamber of Commerce 4th of] ufy Celebration, and Art Soup Celebration. <br /> <br />Submit Application to: City of Elk River <br />Joan Schmidt, Ci!JI Clerk, 13065 Orono Parkwqy,Elk River, MN 55330 <br />Question regarding this application mqy be addressed to the City Clerk at (763) 635-1000 <br />S:\CLERK\LI CENSES\Special Events \SpEV entapplica tion.doc <br />