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Community Development Department <br /> 18070 Collins Avenue,3rd Floor Sunny Isles Beach,Florida 33160 <br /> Phone:(305)792-1772 Fax:(305)792-1569 <br /> Public BeacWPark Events Permit Application <br /> (Cba'ter 201-5G.Rule19(a)-Parks&Recreation Areas) <br /> Ia <br /> From 500 people and above 53,150.00(Application Cleaning Inspection Fee) <br /> S 500.00 Cleanup Deposit Fee(Refundable after cleaning inspection) <br /> 515.00 Fee for Revised Permit Approvals <br /> Allowed:Chairs,Runner,Arch,Table,Floral Arran.ements,Tents or Flooring.Caterint,Amplified Music <br /> ;:.■,,,::!_10)10110141 <br /> Premise Type(check one): Residential( ) Commercial( ) <br /> C \"( <br /> 'Mt& CI <br /> t 'tv 1:J <br /> It 4, State t L Zip <br /> r;A<S\,. t <br /> Phone# Fax# <br /> .< City State Zip <br /> Phone# Fax# <br /> \ <br /> „vitt ‘.1 t 1"j`"( klf\ r) <br /> Phone# Fax# C k ■!..1 es: :\ '\ (,:ss‘ k-'01, t.`• <br /> Emergency Contact: A Phone# Fax# E-mail: <br /> Address a.$;;-t. \6..k..c‘i, cityk1 State L Zip ..P.) <br /> Description of Event ,L)1 ;,::‘cr. ( <br /> Location of Event: t 4 •°:. ' <br /> Music/Broadcast ss if : Number of Guests: <br /> Date of Event: t Hours of Event(. .11 L. <br /> Insurance Required El Yes 0 No Hold Harmless Required Ei Yes ID No <br /> Will Alcohol be served during the event?[] es E:1 No t-k) <br /> '-\ <br /> Police presence .uested? fles ri No No.of Police Officers needed: <br /> No.of Lifeguards =1:(•;7:Si : <br /> THIS APPLICATION DOES NOT APPROVE USES UNAUTHORIZED BY CITY CODE <br /> Ankh.,,ar applicant <br /> This application is for the event as described henna sad that event foe which permit is hereby renovated does not notation.a threat to public safety;consume a danger or impediment to the <br /> normal Soo of mac;or merciful*a potential disturbance of the perm and quiet of the percent outaids the remises adooe the event I.binned.Purtherroore I understand that any permit that <br /> may be granted batted on dab application ht au*oo to enforcement under the City Code of Ordinances and must be autteradered upon demand to the City Code Enhancement and livening <br /> Dept.and/oe Sonny Idea Beads Police Dept. I also understand that,based on the 4..1r:ion of my event,I may be requited to how Lifeguards or Patine Officers presence,n an additional <br /> OW. <br /> grO Signature of Applicant f" ID Signature of Property Owner <br /> I. <br /> .Yr/Alt* <br /> Date Date <br /> Subscribed and Sworn before me this 17sl day of 1 A 4 Subscribed and Sworn before me this day <br /> — <br /> (year) 1.cj 5 of (year) <br /> by , - a by <br /> Check one 4 Ntimwettweeittevskr Check one 0 Personally Known 0 Produced Identification <br /> Type of• „4111P• i • . s . . - Type of Identification(If any <br /> Ity Canoes.Expires Oise 12,2018 <br /> Commission• <br /> Notary' Notary Public <br /> Notary Stamp <br />