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SPECIAL EVENT REQUEST FORM Murray City Corporation 5025 South State Street, Room 115 Murray, Utah 84107 (801) 264-2607 Fax: (801) 264-2618 (Return completed form to the address above.) Name of Organization: Event Description: Event Location: City Ut Zip (attach map of proposed route or site with barricade plan) Event Date(s): Start End Time(s) a.m. p.m. to a.m. p.m. Contact Person: Phone: Address City UT Zip Special Event Sales Tax # (if applicable) Expected # of attendees: (Salt Lake Valley Health must be contacted to determine if other requirements must be met.) Selling food or drinks? Yes No Serving food or drinks? Yes No Beer or alcohol? Yes No (If alcohol is served, the State Division of Alcohol Beverage Control must be contacted to determine if other requirements must be met.) Tents used for this event? Yes No (If yes, contact Fire Dept. to obtain a Tent Permit: [PHONE REDACTED]) Non profit event? Yes No Will event require Police assistance, street closures or traffic obstacles? Yes No Please provide additional information about the event including any services required from City departments (Power, Water, Police, Fire, Public Services, stage, sound systems, etc.) The undersigned acknowledges that the information in this application is true and correct and agrees to adhere to all rules, regulations, and policies established by Murray City. Applicant also understands that an Event Permit does not authorize any violation of the provisions of Murray City Code or any other code or law, rules, regulations or ordinances including requirements imposed by the Utah Division of Alcohol and Beverage Control and Salt Lake Valley Health. The undersigned agrees to waive and release all rights and claims that might be had against Murray City for any and all injuries or losses suffered because of participation in or use of Murray City facilities or services. Undersigned agrees to reimburse Murray City for all costs incurred by Murray City as a result of the event including public safety, garbage, park maintenance, clean-up, and power. Signature: Date: Departmental Use Only Approved/Denied by: Tim Phil Roberts__________ Craig Kim Doug Bruce SIGN ---PAGE BREAK--- RESIDENTIAL PERMISSION SLIP (For neighborhood functions only) Event Description: will be held on Time(s) a.m. p.m. to a.m. p.m. Event location _ City , UT Zip In order to be in compliance with Murray City requirements, signatures from all those residents whose properties will be directly affected by this event (i.e. street closure, amplified sound, etc.) must give written permission for this event to be held. Please sign below if you have no objections to this event being held at the above location. Printed Name _ Signature _ Address Comments: ---PAGE BREAK--- PROPERTY OWNER AUTHORIZATION FORM (To Be Completed and Signed by Property Owner) Property Owner Name: _ Phone: Property Address: _ City , UT Zip Name of Organization: _ Contact Person: _ Phone: _ Address: City: , UT Zip Event Description: Dates Approved: Start: End: Time(s) a.m. p.m. to a.m. p.m. Number of Attendees Authorized: Additional information or comments: As the above listed property owner, I hereby give my permission for the event listed above to be held at the above address during the listed dates and times. I acknowledge that the information given is true and correct and agree to adhere to all rules, regulations and policies established by Murray City Corporation. The undersigned agrees to waive and release all rights and claims that might be had against Murray City Corporation for any and all injuries or losses suffered because of participation in or use of Murray City facilities or services. Signature: Date: SIGN