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2. PLEASE NOTE
   This application is for large gatherings/special events on PUBLIC (city) property only. For large gatherings/special events on PRIVATE property, please contact the City Clerk at (651) 322-2003.
4. APPLICANT INFORMATION
6. Full Legal Name of Applicant*
8. Business or Organization Name (if applicable)
10. Applicant Address*
12. City
13. State
14. Zip
16. Main Phone*
17. Alternate Phone
19. Email Address*
21. Date of Birth*
    Date of Birth
22. Drivers License Number*
24. For Businesses and/or Organizations Only - List all Partners and/or Officers
26. EVENT INFORMATION
28. Name of Event
30. Event Location*
    -- Select One --Bloomfield ParkBrockway ParkCentral ParkErickson ParkFamily Resource CenterJaycee ParkMeadows ParkShannon ParkOther
32. Date and Start Time of Event*
    Date and Start Time of Event

    Date and Start Time of Event
34. Event Ending Time*
    Event Ending Time
    NOTE: Events must end by 10 p.m. unless granted a waiver by the Rosemount City Council
36. Time of Setup
    Time of Setup
37. Time of Cleanup
    Time of Cleanup
39. Estimated number of people attending*
41. Who is financially responsible for event?*
43. Is there a cover charge or entry fee for the event?*

    1. Yes
    2. No
45. If Yes, how much?*
47. Ever been denied this type of permit?*

    1. Yes
    2. No
49. Do you need barricades to block streets?*

    1. Yes
    2. No

    NOTE: If requested, barricades will be delivered on the day of the event and will be picked up on the next business day following the event. For weekend events, barricades will be delivered Friday and picked up Monday.
51. If Yes, list the streets to be blocked off and specify drop-off location for barricades*
53. Detailed description of event*
55. Detailed parking plan for the event*
    NOTE: Parking may be limited at some locations. Please provide a specific plan, including remote parking locations and any shuttle service that may be used.
57. Site Plan / Map
    Attach a drawing that details the venue. Include band location and direction they will be playing, bar locations, food and beverage vendors, entrance/exit gates, perimeter fencing, restroom facilities, refuse containers, relationship to existing buildings, road closures, parking, etc. IF YOU CHOOSE NOT TO SUBMIT A SITE PLAN NOW, STAFF WILL CONTACT YOU TO SUBMIT ONE VIA EMAIL OR IN PERSON.
59. ENTERTAINMENT AND RELATED ACTIVITIES
61. Will there be music features to your event?*

    1. Yes
    2. No
63. If Yes, please list the type of music, all bands/performers, and the sound check and performance schedule*
65. Will there be inflatables (bounce house, obstacle course, inflatable pool, etc)?*

    1. Yes
    2. No
67. If Yes, please describe quantity and type*
69. Will there be fireworks, lasers, rockets or other pyrotechnics?*

    1. Yes
    2. No
71. If Yes, please describe quantity and type*
73. Will there be any signs, banners, decorations or special lighting?*

    1. Yes
    2. No
75. If Yes, please describe in detail*
77. Will there be massage activities?*

    1. Yes
    2. No

    NOTE: All massage activity must be licensed through the City of Rosemount
79. If Yes, please describe in detail*
81. Will there be a water component (hot tubs, pools, slip-n-slides, dunk tanks, etc)?*

    1. Yes
    2. No
83. If Yes, please describe in detail*
85. ALCOHOL
87. Will there be alcohol at the event?*

    1. Yes, free or host-provided
    2. Yes, for sale
    3. Yes, both free and for sale
    4. No

    NOTE: A special permit may be required for the sale, use and/or distribution of any alcohol
89. If Yes, describe your security plan to ensure the safe sale or distribution of alcohol*
91. SECURITY / MEDICAL
93. Describe your security plan for crowd control, internal security and venue safety*
95. FOOD CONCESSIONS / PREPARATIONS
97. Does your event include concessions and/or food preparations areas?*

    1. Yes, concessions
    2. Yes, preparation and serving areas (potluck, picnic)
    3. Yes, both
    4. No

    NOTE: Permits from the MN Department of Health may be required
99. If Yes, please describe in detail
101. OTHER INFORMATION
103. Will you have items or services for sale?*

     1. Yes
     2. No
105. If Yes, please describe in detail
107. Will there be gambling (bingo, pull tabs, raffle, etc)?*

     1. Yes
     2. No

     NOTE: A special permit may be required from the State of MN Gambling Control Board
109. If Yes, please describe in detail
111. Will there be temporary structures (tents, stages, lean-to's, etc)?*

     1. Yes
     2. No
113. If Yes, please describe in detail
115. Will this event be open to the public?*

     1. Yes
     2. No
117. Will this event be marketed, promoted, or advertised in any manner?*

     1. Yes
     2. No
119. If Yes, please describe all means of promotion
123. Portable Restrooms
     You are required to provide portable restroom facilities at your event. The required amount of both ADA-accessible and non-accessible facilities will be based on your anticipated attendance. You are required to use the current City-contracted provider if your event is located on City property.
125. Sanitation and Recycling
     You are required to provide trash cans, dumpsters and recycling receptacles at your event. The required amount will be based on your anticipated attendance. You are required to use the current City-contracted provider if your event is located on City property.
127. Please describe your plan for sanitation and clean-up during and after your event*
129. APPLICATION CONFIRMATION
131. Insurance*

     Your event may require insurance. Specific types and amounts of coverage will be determined after a review of your application. Permits will not be authorized until insurance coverage has been obtained.

     1. I have read and understand the above statement
133. Changes to Application*

     This application must be fully completed and submitted to the City of Rosemount at least sixty (60) days BEFORE your event. ANY CHANGES TO THE APPLICATION ONCE IT IS SUBMITTED MUST BE DONE IN WRITING 14 CALENDAR DAYS AFTER SUBMISSION OF YOUR APPLICATION.

     1. I have read and understand the above statement
135. Fees (to be determined upon review of application)*

     I understand that the permit application fee is non-refundable and does not include the cost of additional fees, including but not limited to: facility rental, portable restroom rental fees, refuse fees, building permit fees, security fees, MN State permit fees, etc.

     1. I have read and understand the above statement
137. Certification and Signature*

     I hereby certify that the information contained in the foregoing application is true and correct to the best of my knowledge and belief, and that I have read, understand and agree to abide by the City's ordinances and regulations governing this proposed Special Event. I also agree to comply with all other local, state, and/or federal laws that are applicable to the Event. I further certify that I understand that allowing non-permitted or unscheduled activities to occur during my event may result in increased costs to me and/or the Organization/Sponsor due to unanticipated operational expenses. I further certify that I, on behalf of myself and/or the Organization/Sponsor, agree to be financially responsible for paying any costs and fees to the City of Rosemount that are incurred by the City or on behalf of the event. If I cancel my event, I will notify the City as early as possible so as to minimize any upfront cost. I understand that I will be charged for City services provided in advance of the event, up through the time of notice of cancellation.

     1. I have read and agree to the above statement
139. Electronic Signature*
     My typed name in the box above shall be considered an electronic signature to this form.
141. Date Submitted*
     Date Submitted
Leave This Blank:


143. 1. Receive an email copy of this form.
144. Email address

     This field is not part of the form submission.

145. Submit

* indicates a required field