Art in the Vineyard, Freedom Fest

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Sf4anAaM Use and Special Use Permit Application -•�i! o � IAN� he completed application form, required City of Eugene Public Works attachments and non - refundable permit fee must be submitted to Public Works, 1820 Roosevelt. 1820 Roosevelt Blvd- Eugene, OR 97402 Applications will be processed in order of receipt and will be granted or (541) 682 -4800 denied with 14 days of receipt, unless the Executive Director or designee extends the processing period by an additional 14 days by written notice to the applicant. -� lf,,after submission of an application but before a decision is rendered, the tlicant submits additional application materials, a decision will be rendered within S��/ 14 days of receipt of the additional application materials. S • Permit application decisions can be picked up at 1820 Roosevelt Blvd. (Mon. - JAN 3 Fri., 8 - 5). Permit denials will be mailed to the applicant at the address given below. 1. Name of event: r a_L C � RS71 - 2. Requested park, open space or park facility (be specific): A L - Iti 3. Date: Time: from to M Estimated Attendance: 4. Event Sponsors: J L W T Representative Name: Phone: Address: - 7Zi, c.J I S 1. ftQr Citymp: l' v)h(' 5. Will this event: (If the answer is yes to any of the questions below, you must obtain a Special Use Permit.) ` A. Have a controlled admission? P'�iS ❑ NO B. Require the erection of canopies, tents, booths or stages? DYES ❑ NO Be advertised as a public event ?RYES ❑ NO D. Amplify sound for more than two hours? ?YES ❑ NO E. Use a park or open space facility as a stag ma site for a public event that exceeds the capacity of the rental facility? ❑ YES ❑ NO 6. Will food be served, sold or given away? YES ❑ NO (If yes, you must provide the City with a copy vf:; temporary restaurant license from Lane Coun . Environmental Health at least 20 days prior to the date of the event) 7. Will alcoholic beverages be sold or served free of charge ? / A YES ❑ NO (If yes, you must comply with the applicable insurance and OLCC license requirements set forth in Administrative Order 58-03 -24-F, Rule 1.004(3).) 8. Will goods or services be sold? ❑ YES P NO (If yes, you must comply with Administrative Rule 1.004(5).) 9. Will equipment, booth, garbage boxes, portable restrooms or a stage be brought to the site ?YES ❑ NO (If yes, this application must be accompanied by a site plan for the park/open space.) 10. Will amplified sound be used (for more or less than 2 hours)? YES ❑ NO (If yes, this application must be accompanied by a schedule of entertainment.) / 11. Will the park or open space be used to hold a race/walk/bike event? ❑ YES ( NO (If yes, this application must be accompanied by a route map for the park and streets.) 12. Is attendance anticipated to exceed 500 people ?! YES 17 NO (If ves. this application must be accompanied by a certificate of insurance that complies with Administrative Order No. 58- 03 -24 -F. Rule 1.004(2xa). Also, if yes, you must provide security and traffic control personnel for the event in compliance with Administrative Order No. 58-03 -24-F, Rule 1.004(6) and this application must be accompanied by a traffic control plan.) 13. All applicable fees must be submitted with this application. Permit fees are non - refundable. if an event is canceled, facility rental fees are refundable in the manner prescribed by Administrative Order of the City Manager_ ❑ Standard Park Permit F : S Special Event Permit Fee: �Faciliry User Fee: $ Q� Security Deposit: $ ��❑ Vehicle Permit Fee(s): ❑ Other 1. ' `" � � " e 11 9 . am the permit applicant. I certify that I am an authorized representative of the above organization (if any). I certify that the above statements are true to the best of my knowledge. I have received a copy of Administrative Order No. 58- 03 -24-F. Park and Open Space Rules, and I and /or the organization 1 represent agree to be 1, ound by all applicable regulations. 1 and /or the organization 1 represent understand that any violation of any of these Feements will result in forfeiture of deposit. immediate termination of event, and jeopardize future use of City facilities. L and/or the organization I represent agree to indemnify; defend, and hold harmless the City of Eugene, its officials, agents and employees from and against any and all claims of injury to property or persons that may arise as a result of any activity occurring at the event for which I seek this permit. I and/or the organization I represent agree to pay all costs of damage and /or vandalism to the park or facilities relation to the event for which I seek this permit. 17, A14V Signature Date Print Name