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Employment Application

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City of Edgewater
Special Activity Permit App 1
Special Activity Permit
Application
104 N. Riverside Drive
Edgewater, FL 32132
Planning@cityofedgewater.org
386-424-2400 ext. 1502
Fee: $100.00/day Case No.
Applicant Information
Name
Phone
Email
Street Address
City
State
Zip
Sponsor Information
Name
Phone
Email
Street Address
City
State
Zip
Event Information
Name
Street Address/location
Date(s)
Hours of operation
Set up/tear down dates
Expected Attendance
Description of Event
Outside music/amplification
☐
Yes
☐
No
Hours
Vendors
☐
Yes
☐
No
#
Type:
☐
Food
☐
Alcohol
☐
Soft Drinks
☐
Arts/Crafts
☐
Other
Which of the following will be used:
☐
Water
☐
Booth
☐
Temporary Signs
☐
Temporary Tents
☐
Canopy
☐
Electricity
☐
Banner
☐
Fireworks/Pyrotechnics
☐
Amusement Rides
☐
Barricades
☐
Portable Restroom #
☐
Trash Cans #
☐
Other (specify)
City services requested
☐
Yes
☐
No
Type
Dates
Times
Type
Dates
Times
Road closures requested
☐ Yes ☐ No
All streets closed for an event must be reopened within 30
-minutes of the end of each day of the event.
Street Name
Dates
Times
Street Name
Dates
Times
City of Edgewater
Special Activity Permit App 2
Required Documents
1. Site Plan reflecting the location and number of vendors, parking layout, and sanitary facilities.
2. Bond or an insurance policy to protect City from liability in form and substance acceptable to City of at least
$500,000 if no on-site alcohol consumption is proposed and $1,000,000 if on-site alcohol consumption is permitted
and/or pyrotechnics are proposed.
3. Activities with expected attendance over 2,000 only - Names and mailing addresses of property owners within 500-
feet of the event site, as obtained from the Volusia County Property Appraisers Office. Note: Names and addresses
printed from the Property Appraisers website will not be accepted. Excel format required if submitting electronically.
4. Non-Profit and/or Charitable Organizations – Tax Exempt Certificate or proof of 501c3 status.
Disclaimer and Signature
This application must be completed in its entirety and submitted to the Planning Department at least 60-days in
advance of the activity with an expected attendance over 2,000 or 21-days in advance of the activity with an expected
attendance under 2,000.
Incomplete applications will be returned to the applicant and may delay approval.
I shall comply with all requirements contained in Section 21-37 (Special Activity Permit Requirements) of the Land
Development Code and Chapter 10, Article III (Noise) of the City of Edgewater Code of Ordinances.
If sound amplification is associated with this event, I agree to monitor the sound level so that it remains within the limits
of the City Code. If valid noise complaints are received, I agree to reduce that noise to a satisfactory level. I further
understand that if reducing the noise does not control citizens’ complaints, the source of the noise will be terminated.
I acknowledge that I am financially responsible for all additional services provided by the City which may include, but
are not limited to trash pick-up, utilities, code enforcement, law enforcement, etc.
I have read and agree to the terms and conditions set forth in this application.
Applicant Signature
Date
City of Edgewater
Special Activity Permit App 3
Notarized Authorization of Owner (To be completed if applicant is not property owner)
I/we as the sole or joint fee simple title holder(s) of the property described as (address or
parcel number) authorize to act as my agent to seek
a Special Activity Permit at the above referenced property.
Owner’s Signature Owner’s Signature
STATE OF FLORIDA
COUNTY OF VOLUSIA
The foregoing instrument was acknowledged before me on this day of , 20 by
who is personally known to me or who has produced as identification
and who did not take an oath.
SEAL
NOTARY PUBLIC
City of Edgewater
Special Activity Permit App 4
Vendor Information (attach copy of applicable state and local licenses)
Business Name
Phone
Email
Street Address
City
State
Zip
Owner Name
Type of Business
Business Name
Phone
Email
Street Address
City
State
Zip
Owner Name
Type of Business
Business Name
Phone
Email
Street Address
City
State
Zip
Owner Name
Type of Business
Business Name
Phone
Email
Street Address
City
State
Zip
Owner Name
Type of Business
Business Name
Phone
Email
Street Address
City
State
Zip
Owner Name
Type of Business
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Employment Application

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Completed 14 July 2020

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