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1 CITY OF LEWISTON Special Event Application Applications must be submitted at least 14 days prior to the event, unless an * appears next to the permit type. *Application must be turned in 30 days prior to the event due to public hearing requirement. Application INFORMATION FOR EVENT ORGANIZER/COORDINATOR Name of Organization: Name of Contact Person for Title of Contact Person: Mailing Address: Daytime Telephone: Cell Phone: Email Address: Contact Name and Cell Phone Number DURING the Is your organization incorporated as a non-profit organization? Non-Profit Number: EVENT INFORMATION Name of Event: Type of Event (walk, festival, concert, etc.): Date of Event: Rain Date: Times of Event: Start Time including set-up: Ending time including clean Actual Event Start Time: Actual Event End Time: Estimated Attendance: Location of Event: If location is a city park, have you applied for use of the property with the Recreation Department and has your request been approved? Yes No Pending Date request submitted to the Recreation Department: ---PAGE BREAK--- 2 TYPES OF PERMITS/PERMISSIONS NEEDED – PROVIDE AN ANSWER FOR EACH LINE: Permit Fee Permission/Permit Type YES NO NOT SURE Separate fee and permit possible FOOD – Will food or beverages be sold or given away? If yes, list what types of food or beverages: Note - A food service license may be required. Separate fee and permit possible NON-FOOD ITEMS – Will products be sold or given away (such as t-shirts, crafts, cds, etc.)? If yes, list what items: Note- A peddling permit may be required. $11 *LIVE MUSIC – Will there be any outdoor musical performances? If yes, please describe: $16/day SOUND AMPLIFICATION – Will there be a microphone or speaker system to project sound? Separate fee and permit required ALCOHOLIC BEVERAGES – Will alcoholic beverages be served? Separate fee and permit required *CARNIVAL – Will carnival rides be offered? If yes, attach a copy of the state permit. A city permit is required as well. Separate fee and permit required FIREWORKS – Will there be a fireworks display? If yes, a permit from the Fire Department is required. N/A PARADE – Will there be a parade? If yes, describe route: Note – A permit from the Police Department is required. N/A RUN/WALK/CYCLE – Will event involve participants doing a walk-a-thon, road race, etc? If yes, describe route: Separate permit required BURN PERMIT – Will there be any open flame such as a bon fire? If yes, describe activity: Note - A permit from the Fire Department is required. N/A TENT/CANOPY – Will you be setting up a tent or canopy? If yes, list number and sizes: N/A ROAD/INTERSECTION CLOSURE – Will any roads need to be closed to accommodate your event? If yes, please list: N/A MAP/DIAGRAM – Is a map or diagram attached detailing this event and depicting the placement of such items as tables, tents, port-a-potties, stage, parking, etc.? This is a mandatory requirement for this application and must be included with the application form. ---PAGE BREAK--- 3 N/A PARKING ACCOMODATIONS – What will be the anticipated need for parking and what is your parking plan? N/A TOILETS – Please list amount at event and/or nearest location: N/A WASTE DISPOSAL – Please list process and location: N/A HAND WASHING FACILITIES – Please list amount at event and/or nearest location: N/A POTABLE WATER – Please list amount at event and location: N/A FIRST AID FACILITIES – Please list location at event: $ TOTAL FEE AMOUNT ENCLOSED – Checks payable to “City of Lewiston”. Please total the amounts listed in the left column and enclose a check with this application. Application cannot be processed without proper payment. Please note that you will be contacted by City Staff if your event requires additional permitting. EVENT LIABILITY INSURANCE COVERAGE FOR EVENT For an event such as a walk-a-thon, race, festival, concert, etc. the City requires insurance coverage – general liability. The City of Lewiston needs to be named as additionally insured in regards to the event activities on that date. Once the event is approved, the Certificate of Insurance will need to be received before the event permits can be issued. Please have “City of Lewiston” listed as additionally insured on the Certificate of Insurance (minimum coverage $1,000,000) and have your insurance company fax a copy to: City Clerk [PHONE REDACTED] DESCRIPTION OF EVENT – Please describe what will occur during your event Signature of Applicant: Printed Name: Date Submitted: ---PAGE BREAK--- 4 Please return this completed application with diagram and any applicable fee to: MAIL: City Clerk’s Office Lewiston City Hall 27 Pine Street Lewiston, Maine 04240 FAX: [PHONE REDACTED] EMAIL: [EMAIL REDACTED] Questions: [PHONE REDACTED] phone Please note: Incomplete applications will delay the processing and may not be processed. Please complete all sections on the form or list “N/A” if a section does not apply to your event so we know that every section was accounted for and not skipped over accidentally. The City needs to have a complete understanding of your event prior to the issuance of permits. Thank you for understanding. ****FOR STAFF USE**** DEPARTMENT COMMENTS AND RECOMMENDATIONS: DEPARTMENT APPROVE DENY DATE INITIALS Sanitarian/Health Inspector Code Officer/Land Use & Zoning Fire Department Police Department Public Works Department Recreation Department COMMENTS/CONDITIONS from any of the above departments: City Council Public Hearing date, if applicable: License Approved/Denied: Date applicant notified: