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Special Use Application
600 NE Grand Ave. www.oregonmetro.gov
Portland, OR 97232-2736
| Special Use Application
APPLICANT INFORMATION
Applicant Name
Business or Organization
Address
Day phone
City/State/Zip
Evening phone
E-mail address Fax
Person to be present during the activity and cell #
Cell:
SPECIAL USE INFORMATION
Type of Special Use (choose all that apply)
General Event
Education
Photography
Filming
Plant Material Collection
Set-up date and time
Take-down date and time
Applicant Signature
Date
Date received
Received by
Application #:
Application Fee Received:
$40
$75 (if site plan is required)
Email this form to specialusepermits@oregonmetro.gov
or fax to 503-797-1849
click to sign
signature
click to edit
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Special Use Application
GENERAL EVENT (a site plan may be required*)
Do you have experience for the requested
activity?
Yes
No
Will you charge participation and/or spectator fees?
Yes
No
If yes, how much?
Will you have food, beverage or other vendors?
Yes
No
If yes, what types?
Do you plan to sell alcohol?
Yes No
Will your activity by underwritten by sponsors?
Yes No
EDUCATION
Number of adults expected
Number of children expected
Number of cars expected
Number of busses expected
PHOTOGRAPHY OR FILMING (a site plan may be required*)
Will your activity have 10 or less people on site?
Yes No**
**If no, a Location Agreement will be issued
instead of a Special Use Permit
List the number of each you plan to have on site.
Cars
Trucks
Generators
Other
PLANT MATERIAL COLLECTION (a site plan is required*)
Species
Plant Form
Estimated amount/gross weight
Collection area within
site
(GPS)
What will this seed be used for?
Where will this seed be used?
Is the species commercially available?
Yes
No
If yes, why collect it rather than buy it?
Why from this particular site?
Species
Plant Form
Estimated amount/gross weight
Collection area within
site
(GPS)
What will this seed be used for?
Where will this seed be used?
Is the species commercially available?
Yes
No
If yes, why collect it rather than buy it?
Why from this particular site?
Species
Plant Form
Estimated amount/gross weight
Collection area within
site
(GPS)
What will this seed be used for?
Where will this seed be used?
Is the species commercially available?
Yes
No
If yes, why collect it rather than buy it?
Why from this particular site?
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