SPECIAL EVENTS PERMIT

SPECIAL EVENTS PERMIT
Permits must be submitted for review at least 30 days prior to the event. The City may take up to 14 calendar days to review prior to providing authorization.
Permittee Information
Name
Address

Address

Street Address Line 2

City State

Zip
Phone#
Contact
Phone#
Cell #
Email
example@example.com
Permit Information
Location
Purpose
Date of Activity

Month Day Year
Date
Start
End
EVENT ATTENDANCE (Select the most appropriate box)

Large Event (501 people or more) Small Event (500 people or less) Parades any size Block Party ** Other
** All block parties must have a signed petition encompassing 80% of the property owners within the footprint of the closure.
SELECT EVENT TYPE AND/OR ROUTE

Street Party 5K Purple - Required Event Provided Personnel (15) 5K Blue - Required Event Provided Personnel (15) 5K Green - Required Event Provided Personnel (15) Parade
It is the sole responsibility of the event coordinator to provide (at a minimum) the required number of volunteers for the selected route as detailed above. Reflective vests will be provided by the City and must be returned (Unreturned vests will be charged $20 Each).
EMERGENCY MEDICAL SERVICES
It is the sole responsibility of the event coordinator to provide (at a minimum) the required number of volunteerfor the selected route as detailed above. Reflective vest will be provided by the City and must be returned (Unreturned vest will be charged $20 Each
Emergency Medical Services must be provided at all events defined as a Large Events.
Is the event producer providing Emergency Medical Services?

YES (please complete Info below) NO
Provider
Office Phone
SIGNS/BANNERS
Please contact Codes and Regulations (502.895.9444)
EVENT CLEAN UP PLAN
Please ensure your event is litter-free. All property adjacent to the event (i.e. streets, right of ways, sidewalks, yards) must be free of waste.

In signing the application for the permit sought hereunder the applicant acknowledges that the above provisions as to the Indemnity of the City of St. Matthews.
Applicant Signature

Clear
Date

Month Day Year
Date
Should be Empty:

SPECIAL EVENTS PERMIT

Permittee Information

Permit Information

EMERGENCY MEDICAL SERVICES

SIGNS/BANNERS

EVENT CLEAN UP PLAN