,
ONLY COMPLETE APPLICATIONS WITH PAYMENT WILL BE ACCEPTED List information of professional organizer or event planner hired for this event, if applicable:
Day of Event ͞ŽŶ-site͟ contact(s):
(Person(s) must be in attendance for the duration of the event and immediately available to City Officials.) Event Type:
Is this a repeat event? NO Yes ʹ If yes, what date was the event last held? ___________ Event Title:_____________________________________________________________________ Event Date(s):___________________________________ Event Start & End Time:__________________________ Setup Date & Time:______________________________ Break Down Date & Time: ________________________ Attendance Per Day:________ Participants Per Day: ______ Admission Fee: NO YES ʹMethod?:_______ Open to Public?: NO YES ʹ Describe:_____________ Phone #/website for public info:__________________ Event Exact Address:___________________________________________ Site Plan Attached: NO YES Authorized
Applicant: ____________________________________________________________________ For Profit
Non- Profit
Contact
Person: ______________________Email: __ Phone:___________________ Address: City, State, ZIP: ell:____ __
Name: __________________________________ Email:__________________ Phone:___________________ Address: ________________________________ City, State, ZIP: ___________ Cell:_____________________ Name: ____ __________________ Email: ____ Phone _______ Name: __________________________________ Email:__________________ Phone:___________________
CITY STAFF
FEE: _______
STAFF INITIALS:
___________
APR. DATE:
___________
Block
Party
Race/
Walk
Concert
Sale/
Expo
Festival/
Carnival
Car
Show Tournament
Fundraiser Vendor
Market
Other: _______________________
Live
Music Parade
Processions
APPLICANT INFORMATIO N
(If a professional event organizer is applying for this permit, a letter from the Chief Officer of the organization authorizing the organizer is required.)
ATTACHMENT 1_SPECIAL EVENT APPLICATION
CITY OF NORWALK
RECREATION AND PARK SERVICESDEPARTMENT
Will all or any part of the event take place on City of Norwalk property? NO YES
Does the event applicant have any employees that will be working at the event? NO YES
Describe parking arrangements in detail for event: Is plan attached? NO YES _________________________________________________________________________________________ Parking & Traffic
Traffic Equipment Required? NO YES, Describe: ________________________________________ (e.g. reader boards, barricades, cones, etc)
List streets that require *closure for this event: ___________________________________________________
*Road closure permit required
Provide a detailed traffic plan for road closures. Is the plan attached? NO YES
Entertainment (Amplified sound requires onsite contact) List ALL entertainment & related activities: ______________________________________________________
Will event have
amplified sound? NO
Describe hours, sound equipment & type of use (e.g. speakers, amplifiers, generators, etc.):
_________________________________________________________________________________________
Will the Special Event include a valet or shuttle service? NO YES, DESCRIBE: ____________________
Will there be fireworks or other pyrotechnics? NO YES, DESCRIBE: ___________________________
Will there be a Drawing Casino - Company Name & Number: ______________________________ As a reminder there is no gambling allowed in The City of Norwalk at any time.
Alcohol & Food
Alcohol at event? NO
Food at event? NO
Will food be prepared at the event? NO YES
Marketing
Describe marketing plan in detail for event: Is plan attached? NO YES _________________________________________________________________________________________
EVENT DETAILS
YES
Indoors
YES
Outdoors
Sound Contact
Name & Number: ___________________________________
YES
Served YES
Sold
If yes, Contact
Name & Number: ____________________________________________ YES
Served
YES
Sold
If yes, Contact
Name & Number: _____________________________________________
CITY OF NORWALK
RECREATION AND PARK SERVICESDEPARTMENT
Structures & Other Equipment
Will there be canopies or tents? NO YES, If yes, size & quantity _______________________________ Date installed: _________________ Date removed: _________________ Supplier Name: _________________
Will booths, bleachers, stages,
or structures be erected? No Yes, Describe: _______________________________________
Will signs or banners be used? No Yes, Describe: ________________________________________ Will there be generators, vehicles,
boats or other equipment? No Yes, Describe: ________________________________________ Will there be Carnival Rides Attractions, Describe: _______________________________________ Will there be commercial filming of this event? ___________________________________________________ Any other commercial aspects? _______________________________________________________________ Additional information:
_________________________________________________________________________________________ _________________________________________________________________________________________ I, the undersigned, acknowledge and understand that I am responsible to comply with the information, restrictions and conditions of the permit. I hereby acknowledge responsibility for penalties associated with non-compliance with the permit conditions, whether or not I am present at the time of the violation. ________ Initials
I hereby certify the foregoing statements to be true and correct, and agree to defend, indemnify and hold harmless the City of Norwalk, its City Council, officers, agents, employees and volunteers from and against any and all loss, claims, damages, liability, such claim or suit arising from or in any manner connected to the requested activity. I also agree, if approved, to comply with all permit conditions, and understand that failure to comply with any condition or any violation of law may result in the immediate cancellation of the event, denial of future events, and or criminal prosecution.
Failure to comply with permit conditions can result in revocation of the permit, forfeiture of deposit, administrative citations, fines and denial of future permit applications.
Print Name Signature Date
Application(s) must be complete with all necessary attachments in order to be accepted & processed. (Insurance, event diagrams, parking plans, community notification, vendor list, other permits, etc.)
AGREEMENT & PAYMENT INFORMATION