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Application for Waiver of Special Event Permit Page 1 of 2 1. Name of Applicant/Organization: 2. Address, City, State, ZIP: 3. Contact Phone Number(s) & Email: 4. Name of Event: 5. Purpose of Event (e.g. fundraiser): 6. Event Location: 7. Complete Description of Event: 8. Event Dates: Event Times: Start: End: Please check all of the following that apply to your specific event: WAIVER OF SPECIAL EVENT PERMIT APPLICATION City of Douglas, Wyoming Please complete this application in its entirety. If a section does not apply to your event, please mark Walking tour Sidewalk Sale or Customer Appreciation event occurring in an area immediately adjacent to property/business promoting the event and not requiring city services. Regularly scheduled school event utilizing existing parking, traffic controls, and public safety support. Public function held solely on the Wyoming State Fairgrounds property. Public function held solely on property owned by Converse County or Converse County School District not requiring traffic control. No city services are needed/required, including but not limited to the following: police and/or fire department presence; traffic control; use of a city building or property; placement of barricades; street or sidewalk closures, including any use of city barricades; need for city dumpsters and/or request for additional dumpsters and/or pickups. Event allows for overnight camping. Event allows for open burning or open flame cooking. Event will have a fireworks display. ---PAGE BREAK--- Application for Waiver of Special Event Permit Page 2 of 2 11. Additional comments/explanations regarding why a waiver of a special event is appropriate: 12. SIGNATURE OF APPLICANT: All Applicants please read the following statement and sign below. I understand and will comply with the conditions of this waiver of a special events permit. If I fail to answer all questions completely and accurately, this permit will not be approved. I understand that an approved waiver may be cancelled at the discretion of the City of Douglas for failure to obey the terms of the waiver, in which case a Special Event Permit will need to be obtained from the City. Signature of Applicant Date Printed name of Applicant Application for Waiver of a Special Event Permit approved: Yes No Date: (If not approved, prepare reason for applicant in writing.) Authorizing Official Signature: Authorizing Official Printed Name/Position: (City Administrator or Designee)