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City of Zephyrhills ; <br /> SPECIAL EVENT PERMIT Planning Department <br /> 5335 8th Street,Zephyrhills;FL 33542 <br /> www.ci.zephyrhil Is.fl.tis <br /> 813-180-0000 <br /> *City Street or Avenue Closure Request? *State Highway Closure(FDOT Larne Closure Permit Required) <br /> ❑Yes(indicate location below) CN�Nb C1 Yes(indicate location below) P(No <br /> *Equipment to be brought on City property(mark all that apply) *Requested City equipment/utilities for event(mark all that apply) <br /> Tents(smaller than 10'x 10') Oki Bathroom Facilities <br /> 11 Tents(larger than 10'x 10'—requires fire rating certificate) ❑Electricity(51h Avenue Median) <br /> QS Vehicles - SezF-�� Electricity(Stage Areas) <br /> 0 Stage GXGarbage Cans <br /> ❑Start/Finish Line ❑Cones/Barricades <br /> El Signs ❑Other(please list below) <br /> (,Tables <br /> kPorta lets <br /> Bounce=House/Inflatabies(requires own COI) <br /> Sound Equipment <br /> ❑People Barricades(City does not own or provide) <br /> ❑other(please list below) <br /> *Brief Description of Event <br /> 14er �25fi`�x �'r, :^� tJ:44 <br /> Zook) �J5 r nQ5y 9 9 1Yirl n'A r+iic>'Kit. lCl��rv+- ap.^v"► $J ti t'1� <br /> i/We agree to obtain and maintain the required liability insurance and secure all necessary local,state and federal permits and to comply <br /> with all terms and conditions applicable to the conduct of special events,as set forth in ordinance No.943.06,as amended. <br /> I/We certify that the information contained in this application is complete,true and accurate to the best of my/our knowledge.As applicant <br /> for the event,fte agree to release and hold harmless the City of Zephyrhills from liability of any kind for any and all damages arising out <br /> of any loss or injury resulting from the conduct of this event and for any and all losses or injury arising while conducting the event using <br /> City of Zephyrhills facilities or property and for any and all losses or injury to persons attending this special event. <br /> I/We certify that individuals will not be barred from participation in this event due to race,creed,color,national origin,sex,age or physical <br /> impairment. <br /> I/We fully understand,acknowledge and agree to all terms and conditions of this form and that failure to meet the terms and conditions <br /> shall result in cancelation of the event. <br /> Signature: Date: + 1ls <br /> Print Name: <br /> City of Zephyrhills Special Event Permit Page 12 2018 <br />