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Standard Use and Special Use Permit Application
<br />'�— City of Eugene
<br />;t •. w
<br />• tie completed application form, required attachments, non - refundable Public Works
<br />.-pen lit fee, and any other fees must be submitted to Public Works at 1820 1820 Roosevelt Blvd.
<br />• Roosevelt Blvd. A separate check for the security deposit is required. Eugene, OR 00
<br />o (541) 682 -4800
<br />• Applications will be processed in order of receipt and will be approved
<br />or denied with 14 days of receipt unless the Executive Director or designee extends the
<br />processing period by an additional 14 days by written notice to the applicant.
<br />If, after submission of an application but before a decision is rendered, the applicant submits additional
<br />application materials, a decision will be rendered within 14 days of receipt of the additional materials.
<br />Permit decisions will be mailed to the applicant at the address below. Standard Use ❑
<br />n Special Use �1
<br />1. Name of event:
<br />2. Requested park, open space or ark facilit be specific):
<br />q P A P P P h' ( 3-�
<br />3. Date: ? `� Time: from t to s I ' ` Estimated Attendance:'),
<br />4. Event Sponsors:
<br />Representative Name: , i r -.. d 'y ' -r �-�- ,. Phone:..,
<br />Address: t.: % i. �'' �` B City /Zip:
<br />E -Mail Address: i { a s. 1 .t ;. is
<br />Will th' ent: (If the answer is yes to any of the questions below, you: must obtain a Special Use Peit,)
<br />A. rm Have a controlled admission (i.e .', require an admission fee)Z;�YES ❑ �NO
<br />Require the erection of canopies, tents, booths, or stages? ❑YES :1� NOS
<br />Be advertised as a public eventl ®
<br />^ YES ❑ NO
<br />Amplify sound for more than two hours? ❑ YES ' NO
<br />E. Use a park or open space facility as a staging site for a public event that exceeds
<br />the capacity of the rental facility? ❑ YES Z NO
<br />6. Will food be served, sold, or given away? ❑ YES Q NO (If yes, you must provide the City with a copy of a
<br />temporary restaurant license from Lane County Environmental Health at least 20 days prior to the date of the event.)
<br />7. Will alcoholic beverages be sold or served free of charge? ❑ YES ,RNO (If yes, you must comply with the
<br />applicable insurance and OLCC license requirements set forth in Administrative Order 58- 03 -24 -F, Rule 1.004(3).)
<br />88.. Will goods or services be sold? ❑ YES , D,,NO (If yes, you must comply with Administrative Rule 1.004(5).)
<br />Will equipment, booth, garbage boxes, portable restrooms, -or a- stage•be- ;brought to -- the - site ? - YES ❑ NO
<br />(If yes, this application must be accompanied by a site plan for the park/open space.)
<br />L0. Will amplified sound be used for more than 2 hours)? ❑ YES KE NO (If yes, this appli cation must be
<br />1 accompanied by a schedule of entertainment.)
<br />Will the park or open space be used to hold a race /walk/bike event? ❑ YES %q NO (If yes, this application must
<br />be accompanied by a route map for the park and streets.)
<br />12. Is attendance anticipated to exceed 500 people ?,`Q YES ❑ NO (If yes, this application must be accompanied by
<br />a certificate of insurance that complies with Administrative Order No. 58- 03 -24 -F, Rule 1.004(2)(a). Also, if yes,
<br />you must provide security and traffic control personnel for the event in compliance with Administrative Order No.
<br />58- 03 -24 -F, Rule 1.004(6) and this application must be accompanied by a traffic control plan.)
<br />13. All applicable fees must be submitted with this application. Permit fees are non - refundable. If an event is
<br />canceled, facility rental fees are refundable in t manner prescribed by Administrative Order of the City Manager..
<br />❑ Standard Park Permit Fee: $ _
<br />❑ Facility User Fee: $ Sec De sit ( eparat Check): $
<br />❑ Vehicle Permit Fee(s): $
<br />er
<br />am th �Ice at I am an author above organization (if any). I certify that the above statements are y owe ge. I have received a copy
<br />of Administrative Order No. 58- 03 -24 -F, Park and Open Space Rules, and I and/or the organization I represent agree to be
<br />1 by all applicable regulations. I and/or the organization I represent understand that any violation of any of these
<br />Cements will result in forfeiture of deposit, immediate termination of event, and jeopardize future use of City facilities.
<br />r and/or the organization I represent agree to indemnify, defend, and hold harmless the City of Eugene, its officials, agents
<br />°�`- �mployees from and against any and all claims of injury to property or persons that may arise as a result of any activity
<br />acing at the event for which I seek this permit. I and/or the organization I represent agree to pay all costs of damage
<br />and/or vandalism to the park or facilities used in relation to the event for which I seek this permit.
<br />Signature Date Print Name
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