Block Party Application
APPLICANT INFORMATION
Applicant Name: _______________________________________________________________
(First) (Middle) (Last)
Address: ______________________________________________________________________
Home Phone: _________________ Daytime Phone: ______________ Cell: _____________
Date of Activity: _____________________________________ Hours: __________________
Type of Activity: _______________________________________________________________
Location of Event: ______________________________________________________________
Temporary Structures: ___________________________________________________________
(Tents 200 sq. ft. or larger require a permit from the fire department)
Public Property Involved: ________________________________________________________
Restroom Facilities: _____________________________________________________________
Traffic Control Provisions: _______________________________________________________
Crowd Control Provisions: _______________________________________________________
Food and/or Drink Displayed for Dispensing: _________________________________________
(No money can be exchanged for alcohol).
I hereby certify that all statements made in this application are true and complete to the best of
my knowledge. I understand that any misstatements or omissions of material facts may result in
the disqualification or denial of the license. I authorize the city of Farmington to investigate the
information and contact persons/organizations named on this application.
Applicant Signature: _________________________________ Date: ___________________
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THIS SECTION FOR OFFICE USE ONLY
Date Application Received: __________________
No Fee.
APPROVED DISAPPROVED
Police Signature: _________________________________________ Date: ____________
City Administrator: _______________________________________ Date: _____________
Comments: ____________________________________________________________________
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