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Special Event Application

  1. This application must be completed, signed, and forwarded to the Jefferson County Administrator at least 90 days prior to the first day of the event. 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. Please type or print information clearly and attach additional sheets as necessary.
  2. Event
  3. Event Type
    (Check 1)
  4. If you selected other as the event type, please specify the type and be specific.
  5. Facilities to Be Used
  6. Event Crowd Size
  7. Has this event been produced previously?
  8. If yes, list changes for this year’s request.
  9. Applicant Information
  10. Exemption Request
  11. Are you requesting exemption from the special event fees?
  12. Fees and Proceeds
  13. Admission Fee
    (Check 1)
  14. If there is to be an admission fee, how much?
  15. Vending or Sales
  16. Please specify any additional vending or sales options at your event.
  17. Entertainment and Promotions
  18. Sound System
  19. Check Type of Promotion You Plan to Use to Attract Participants:
  20. Have local neighborhood groups or businesses approved your event concept?
  21. List Community Contacts and Phone Numbers (for Verification)
  22. Special Set-Ups Requested
    Describe various categories and fill in details on numbers, size and type. Leave blank if not applicable.
  23. Animals
  24. Booths
  25. Commercial Signs
  26. Electricity Signs
  27. Fireworks
  28. Portable Restrooms
  29. Rides
  30. Staging/Scaffolding
  31. Tents/Canopies
  32. Vehicles
  33. Water
  34. Noise Variance
  35. Public Safety
  36. Attach a clear, legible site and/or route map with the following indicated: - North, indicated by directional arrow - Names of streets with one-way streets marked - Number and placement of barricades - Any other details you think will be helpful
  37. Insurance Information
  38. Will liquor be served at this event?
  39. Garbage and Recycling
  40. Are you providing garbage and recycling containers?
  41. Traffic Control Plan
  42. Police officers are required at all signalized intersections. Flaggers are required at all non-signalized intersections. Monitors may be required at driveway entrances and other pedestrian and vehicle access points.
  43. (specify if monitor, flagger, or police officer)
  44. (specify if monitor, flagger, or police officer)
  45. (specify if monitor, flagger, or police officer)
  46. Leave This Blank:

  47. This field is not part of the form submission.