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FAYETTE COUNTY SPECIAL EVENTS PERMIT 140 W. STONEWALL AVE., FAYETTEVILLE, GA. 30214 Date: Fee: Check/Cash: Office Use Only LOCATION (Where event will take place): PERMITTED LOCATION PERMIT SPECIAL EVENT FEES APPLICANT INFORMATION Malt Beverage— $75.00 Wine— $50.00 Distilled Spirits— $125.00 All the above— $200.00 Applicant Name: Address: Street State Zip Telephone: Cell Email: Name of Primary Contact (Must be on site during event): Phone # of Primary Contact: DATES REQUESTED thru EVENT TYPE ACTIVITY DESCRIPTION CHECK ALL THAT APPLY TO THIS ACTIVITY Party/Festival Reception/Wedding Fundraiser Other (describe:) Catered Food with Alcohol (Must be Permitted Location) Amplified Sound/Music (Art. II, Sec. 16-35 — 16-72) Tents/Canopies Other (describe) Alcohol Provider Caterer Information Special Event Applicant Licensed Alcohol Beverage Caterer—_________ Name of Caterer : Business Address of Caterer: Alcohol License #s State: Local: Licensed Alcohol Beverage Caterer Signature: Phone: ATTENDANCE ANTICIPATED SPECTATORS ANTICIPATED PARTICIPANTS EVENT DATE/TIME DATE Estimated Total Estimated at Peak Time EVENT START DATE: EVENT START TIME: Total Attendance EVENT END DATE: EVENT END TIME: SIGNATURE OF APPLICANT OR DATE: