Fillable City of Des Moines SPECIAL EVENT APPLICATION (City of Des Moines)

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City of Des Moines SPECIAL EVENT APPLICATION (City of Des Moines)

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For Office Use Only
Permit No.________
City of Des Moines
SPECIAL EVENT APPLICATION
Return to: Phone: (206) 870-9370
Fax: (206) 870-6587
City of Des Moines Events Office
ATTN: Ashley Young
Events and Facilities
22307 Dock Ave South
Des Moines WA 98198
ayoung@desmoineswa.gov
This application must be completed, signed and forwarded to the City of Des Moines at least ninety (90) days prior to the first day of the event
(unless authorized by the City Manager). Applications submitted less than 90 days prior to the event may be denied or subject to additional
review fees. Any misrepresentation in this application or deviation from the final agreed upon route and/or method of operation described herein,
may result in the immediate revocation of the permit. Submittal of this application in no way constitutes City of Des Moines approval of the event.
Permits are issued at the discretion of the City of Des Moines upon thorough application review. The City of Des Moines reserves the right to
reject any Special Event Permit application request for any reason. Please type or print information clearly and attach additional sheets as
necessary.
1. EVENT INFORMATION
Event Name:
Festival/Fair Concert/Amplified Private Event Music/Theatrical
Block Party Boating/Rowing Car/Boat Show Exhibits/Displays
Sporting Event Swim/Wind Surf Commercial Event Food Beverage Vendors
to promote your event go to www.destinationdesmoineswa.org for more information
Sporting Event Swim/Wind Surf Commercial Event Food Beverage Vendors
Event Type: Bicycling Rally/Protest Wedding/Reception Merchandise/Services
Outdoor Market Run/Walk Triathlon Vendors
Photo Shoot/Film Religious Fireworks Other (describe)
Public Address/PA Systems MaST Facility Use Parade
Start Day (of week): End Day (of week): Hours:
Start Time
(example 12:00pm): End Time (example 12:00pm):
Event Date(s): Open until
Indicate Dates/Times Date: Date: closing
OPEN to Attendees Each Day
Start Day: End Day: Setup/Take
Start Time
(example 12:00pm): End Time (example 12:00pm):
Setup/Take Down Down Hours
Dates: Date: Date: Daily:
Describe in detail and attach black and white maps and layouts:
Event Location:
# of Participants: # of Spectators: # of Staff/Volunteers: TOTAL Attendance Expected:
# of Participants: # of Spectators: # of Staff/Volunteers: TOTAL Attendance Expected:
Event Size: (Add all 3 columns)
Has this event been produced before? Is this an Annual Event? Previous Names(s) of Event: How Many Years?
Yes No Yes No
Are there any changes from previous Describe Changes:
years?
Yes NoYes No
Is this event public? If open to the public, please check all advertisement methods:
Is this event private?
TV Radio Internet Posters A -Board* Banners* Inflatable Display
Briefly describe your event here. Attach additional documents if necessary. *The use of Temporary Special Event Signage (A-Boards,
Banners) requires a Sign Special Use Permit. Contact Planning, Building and Public Works at 206-870-7576 to obtain permit.
Yes No
Yes No
City of Des Moines Special Event Package
2. APPLICANT INFORMATION
Sponsoring/Producing Organization Name:
Street Address:
Mailing Address:
City, State, Zip:
Name: Name:
Applicant Contact:
Secondary Contact:
2 City of Des Moines Special Event Package
Applicant
Contact:
Secondary
Contact:
Title: Title:
Phone: Fax: Phone: Fax:
Email: Email:
Organization/Event Website: http://www.
3. PARK, RECREATION & MARINA FACILITIES
Events held at Des Moines Parks and Recreation facilities require a Park Use Permit, with separate fees Please familiarize yourself with the Park
and Recreation Use Permit Application to understand the conditions, limitations and fees for events on Parks Property. For more information
regarding facility rentals please contact the Parks and Recreation Office at 206-870-6527 or recreation@desmoineswa.gov.
Events held at Des Moines Marina facilities require a Marina Use Permit, with separate fees. Conditions, fees and limitations for events are in the
Marina Tariffs. For more information regarding Marina rentals please contact the Harbormaster's Office at 206-870-6724 or marina@desmoineswa.gov.
Is your event partially or fully held at a City Park Facility(ies) requested: Have you completed a Park Use or Marina
of Des Moines Park or Marina? Yes No Marina Facilit
y(
ies
)
re
q
uested: Use A
pp
lication Yes N
o
of
Des
Moines
Park
or
Marina?
Yes
No
Marina
Facility(ies)
requested:
Use
Application
Yes
No
Recreation Facility Requested: Activity Center Field House Founder's Lodge Have you completed a Facility Use
Picnic Shelter Requested: Midway Field House Park Wooton Park Application Yes No
Disclaimer: The City of Des Moines does not endorse any products, programs or services that are presented. Each individual is responsible for
making informed decisions regarding these services, programs or products. Submittal of this application in no way constitutes City of Des Moines
approval of the event. Permits are issued at the discretion of the City of Des Moines upon thorough application review. The City of Des Moines
reserves the right to reject any Special Event Permit application request for any reason.
4. FEES &
Admission Fee? Amount? Will you have vendors selling goods or services on park property?yggpppy
PROCEEDS
Yes No $ Yes No
Items to be sold: Food Beverages Merchandise Services Other
15% of gross commercial sales (food beverages, admissions, souvenirs, goods, and services) on Parks property must be remitted to Des Moines
Parks and Recreation Department within 10 days following the event.
5. VENDORS
Does your event have vendors selling food, beverages, merchandise or services? Yes No
If yes, please contact Planning, Building and Public Works at 206-870-7576 or visit www.desmoineswa.gov
fBi Li if ti d i tfor Business License information and requirements.
6. ALCOHOL
The sale, service and consumption of alcoholic beverages are subject to Washington State Liquor Control Board
(WSLCB) regulations, licensing and permit requirements. Special Occasion licenses are issued only to non-profit
societies or organizations holding a special event at which spirits, beer or wine is sold by the drink. The City's liquor
liability limits apply to events in which alcohol is sold. Non profit organizations must apply for a Special Occasion
License 45 days prior to the event. Your event may require a different type of permit. Please visit the WSLCB
website, www.liq.wa.gov
for additional information.
Will alcohol be sold or consumed? Is a non-profit organization providing the alcohol service? Yes No
Yes No If Yes indicate name of non profit organization:
Yes No If Yes, indicate name of non-profit organization:
If No, indicate alcohol service provider:
Beer/Wine Garden Days & Dates: Hours:
Describe intended or requested sale and/or consumption of alcoholic beverages at your event:
2 City of Des Moines Special Event Package
7. FOOD
If you plan to sell food or have food vendors at your event, Public Health Seattle & King County Temporary Food
Service permits may be required for each food vendor or sales/serving location. The Temporary Food Service
application and fee are due at least 14 days prior to the event. Additional requirements are listed on the
application available at www.kingcounty.gov/health
or contact Renton Public health at 206-296-4700.
Do you plan to sell food at your event? How many food vendors will you have Will food be hot/cold held or cooked onsite?
at your event? Yes No
Potentially hazardous food must be kept
hot at 140F or more or cold at 41F or less.
3 City of Des Moines Special Event Package
Only limited food preparation is allowed onsite at an event. A commercial kitchen is required for most food preparation. Handling
unpackaged food requires a barrier such as gloves, tissue or tongs and a hand-wash station available INSIDE the food booth (an insulated
container with 5 gallons of gravity flow hot water, soap and paper towels). Food vendors are required to be within 200 feet of a restroom
with a hand sink that has hot and cold running water for food workers.
Please describe the food service at your event:
8. NEIGHBORHOOD
Please provide a community outreach and notification plan with your application for events such as parades,
COMMUNICATION
road races, festivals, neighborhood block parties with details regarding how residents and businesses
will be notified in the neighborhood where your event takes place, and if there will be street closures, impact to
parking areas, traffic delays or amplified sound:
9. AMPLIFIED
Special review is required if your event has Amplified sound (PA system) or music after 10:00pm or during early
SOUND/MUSIC
morning hours before 7:00am on weekdays and 9:00am on weekends.
Does your event have Does your event have amplified Dates:
amplified sound? music and entertainment?
amplified sound? music and entertainment?
Yes No Yes No
What times are you requesting amplified sound? Please list dates and start and end times below:
Date: Date: Date: Date:
Start: End: Start: End: Start: End: Start: End:
10 EQUIPMENT SET/UP
Pl h k ll b th t l RtiEltiit
10. EQUIPMENT SET/UP
Please check all boxes that apply: Requesting Electricity
Commercial Signage Generators Tents/Canopies # Fireworks Portable Restrooms
Inflatable's/Bouncy Toys Hand washing Stations Staging/Scaffolding
Please contact the Department of Planning Building and Public Works at 206-870-7576 if you have special electrical needs or if you will have
tents/canopies at your event to determine if a separate permit is required.
Please list the outside company/vendor that you are using for any of the checked boxes above:
11. RECYCLE
Washington State law requires vendors and organizers for festivals, sports facilities, special events and official
& TRASH
gatherings to provide recycling containers at events where beverages in cans and/or bottles are sold.
See RCW 70.93.093 for complete language.
Will beverages in cans or bottles be sold Are you providing recycling containers at How many recycling containers will you have
at your event? Yes No your event? Yes No at your event?
How many large trash dumpsters will you have onsite at your event? How many large recycling dumpsters will you have onsite at your event?
What size? What size?
How many waste containers will you Will you be managing your own waste and recycling?
Yes No
have at your event? Will you be hiring an outside vendor? Yes No
If you are hiring an outside vendor, please identify the company you are working with and include onsite, weekend or emergency
numbers for them.
Name
Telephone Email
Please describe your waste and recycling plan.
3 City of Des Moines Special Event Package
Yes
Please include information regarding collection of recyclables including cans, bottles, cardboard, paper, food and other compostable items
if applicable.
12. STREET USE
Events that require the use or closure of public streets are required to submit a detailed description of the
& METRO
intended usage and/or closure and detailed maps to support the request. A right of way permit may be
be requested/required.
Barricades, traffic cones,
"
No Parking
"
signs, etc., may be required by Des Moines Planning, Building and Public Works Department as
4 City of Des Moines Special Event Package
Barricades
,
traffic
cones
,
No
Parking
signs
,
etc
.,
may
be
required
by
Des
Moines
Planning
,
Building
and
Public
Works
Department
as
part of the Traffic Control Plan and are at the expense of the permit holder and are not included in the Special Event Permit Fee.
Does your event require Do you plan to use street If your event requires either of these, or affects any streets,
any street closures? parking spaces? please attach a detailed map and description of the areas
Yes No Yes No affected.
What times are you Do you anticipate affecting or re-routing any Metro bus routes?
requesting to close the Start Time: Yes No
streets? End Time: If yes, please list routes and note route locations on your street use map.
Please describe your street use:
Pl
ease
d
escr
ib
e your s
t
ree
t
use:
13. FIRE
City special events may require fire permits. The cost of these permits may not be included in the Special Event
Permit Fee. Fire permits may be required for carnivals and fairs, tents/canopies, places of assembly, open flame cooking
(with propane, charcoal or wood), fireworks and other uses. Contact South King County Fire and Rescue
at prevention.web@southkingfire.org Size of Tents:
14 MEDICAL
Does your event require onsite medical assistance or first response providers standing by:
14
.
MEDICAL
Does
your
event
require
onsite
medical
assistance
or
first
response
providers
standing
by:
Yes No
15. POLICE &
Special events may require the use of police officers for crowd and traffic control or other purposes. These needs
TRAFFIC
will be determined at your event review.
16. CITY OR
Police Department: Crowd Control, Security or Traffic Control:
PUBLIC
SERVICES
RE
Q
UESTED
RQUS
City Staff Presence:
Barricades, Street Closures or Detours
Special Park Maintenance or Set Up
Street Sweeping/Clean Up
Assistance with Banner or Sign Placement
4 City of Des Moines Special Event Package
First Aid Onsite
Electrical Hookup to City venue power source
5 City of Des Moines Special Event Package
17. INSURANCE Evidence of insurance must be provided to the Des Moines Parks, Recreation & Senior Services office no later than
thirty (30) days prior to the commencement of the event. A Special Event Permit will not be issued until all insurance
requirements have been received, verified and approved.
The City of Des Moines must be listed as an additional insured. The Certificate of Additional Insured must be
accompanied by the policy endorsement forms CG20 12 or CG 20 26 or equivalent or it will not be accepted.
Please fax or e-mail your proof of insurance to the Special Events Office, Attn: Ashley Young.
Contact information on page 1 of this form.
18. EXEMPTION
Are you requesting an exemption from the Special Event Permit Fee? Yes No
REQUEST
If Yes, state the reason for the exemption (i.e., constitutionally protected free speech, religious and political
expression are accepted reasons for an exemption; non profit status by itself is not sufficient for exemption). Fee
exemptions apply only to the Special Event Permit Fee and do no apply to other department's permit fees.
19. SIGNATURE I certify that the information that I have provided in this application is true and accurate to the best of my knowledge.
If the event plans change I will submit a revised application or additional information accordingly
If the event plans change, I will submit a revised application or additional information accordingly.
All documents received by the Special Events Office are public documents and subject to public disclosure in
accordance with the State Public Disclosure Act.
Print Applicant's Name Date
Applicant's Signature (see below for electronic signature) Date
Date:
By checking this box as an electronic signature, I agree to all the terms and conditions that may apply to the
Special Event permitting process and agree that all information contained in this application is true and correct to
my knowledge.
20. CITY
Police Department Approval Yes No
CLEARANCES
Special Conditions Yes No
& SPECIAL
Department Contact:
CONDITIONS
Conditions or Comments:
(City Use Only)
Estimated Cost $
Building Division Approval Yes No
Special Conditions Yes No
Building Permit Required? Yes No
Department Contact:
Conditions or Comments:
Estimated Cost $
Transportation Engineering Yes No
Special Conditions Yes No
ROW Permit Required? Yes No
Department Contact:
Conditions or Comments:
Estimated Cost $
5 City of Des Moines Special Event Package
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Marina Approval Yes No
Special Conditions Yes No
Department Contact:
Conditions or Comments:
Estimated Cost $
Parks & Recreation A
pp
roval Yes No
6 City of Des Moines Special Event Package
Parks
&
Recreation
Approval
Yes
No
Special Conditions Yes No
Special Event Sign Permit? Yes No
Facility Use Application? Yes No
Department Contact:
Conditions or Comments:
Estimated Cost $
Street Superintendent Approval Yes No
Special Conditions Yes No
Department Contact:
Conditions or Comments:
Estimated Cost $
Surface Water Management Approval Yes No
gpp
Special Conditions Yes No
Department Contact:
Conditions or Comments:
Estimated Cost $
SK Fire & Rescue Approval Yes No
Special Conditions Yes No
DC
Department Contact:
Conditions or Comments:
South King Fire Permit Required? Yes No
Estimated Cost $
City Manager/Administration Approval Yes No
Special Conditions Yes No
Ct tR id?
Y
N
Contract Required? Yes No
City Council Resolution Required? Yes No Resolution No:__________
Business License Required? Yes No License No: ____________
Department Contact:
Conditions or Comments:
Estimated Cost $
Total City Cost: $
Special Event Permit Fee: $
TOTAL CHARGE: $
6 City of Des Moines Special Event Package
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Completed 3 August 2020

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