Event Application Form

The type of permit you are applying for (mark all that apply):

Public Dance - PO.5.40.010
Parade - PO.5.12.030
Noise Variance - PO.9.12.080
Entertainment - PO.5.20.010
Road Closures/ Parking Spaces - PO.12.28.010 - MUST notify Streets Department for barrel set up at 754-9513 or ametzler@cityofpowell.com
Block Party - PO.12.28.010 - MUST fill out and submit Block Party form with application

If applicable, please attach a map or route when submitting application.

FEES

FEES ARE NON-REFUNDABLE

Parades: $15
Public Dance or Entertainment permit: $10
Late fee for Dance or Entertainment permit if less than 14 days from event: $120

Date and Time of Event

Date

Time

Location of Event

Reason for Permit

Sponsored By

Contact Person

First

Last

Contact Phone

**This permit is a privilege granted by the city and may be revoked in the event the permitted activity in any way results in a disturbance.

the INTERNAL DEPARTMENT

INTERNAL DEPARTMENT USE

Do Not Fill Out

Approved by

Chief of Police or Designee

For department use only.

Signature of Approval

Clear Signature

For department use only.

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