Laserfiche WebLink
Attachment 1 Reed Date: <br /> Port of Special Use Permit Application <br /> FUER F.TTStaff initials: <br /> Port of Everett, PO Box 538,Everett,WA 98206 PORT OFFICE USE ONLY <br /> Phone:425.259.3164, Fax:425.252.7366 <br /> LOCATION USE/ACTIVITY INFORMATION <br /> O Jetty Landing O Boat Launch O Travelift Dock O Fisherman's Tribute Plaza <br /> LOCATION(S) O Boxcar Park O Port Gardner Landing* O S. Marina Promenade* O Commodore Plaza* <br /> REQUESTED: O S. Marina Navy Park* O Other(please specify): <br /> Please identify desired location(s)above as well as Indicating on the attached map (*subject to master leaseholder consensus) <br /> DATE(S)REQUESTED: <br /> TIME REQUESTED: FROM: EVENT START TIME: FROM: <br /> (Including set-up&breakdown time) TO: END TIME: TO: <br /> DETAILED DESCRIPTION OF USE: (Additional page(s)of information is preferred) <br /> EQUIPMENT TO BE USED ON-SITE(i.e.tent,staging,risers,equipment,etc): <br /> ESTIMATED NUMBER OF EVENT STAFF: ESTIMATED NUMBER OF VEHICLES: <br /> ESTIMATED NUMBER OF ATTENDEES: ESTIMATED NUMBER OF CARS/HR:: <br /> O ENTIRE EVENT OR O PER HOUR: <br /> WILL FOOD BE SERVED? O YES O NO WILL ALCOHOL BE SERVED? O YES* O NO *Must follow Special Use Policy) <br /> WILL MUSIC BE PLAYED? O YES O NO IS EVENT OPEN TO THE PUBLIC? O YES O NO <br /> UTILITIES REQUESTED: O WATER O POWER O OTHER: <br /> *Fees apply <br /> APPLICANT INFORMATION <br /> APPLICANT/ORGANIZATION NAME: <br /> CONTACT PERSON: <br /> ADDRESS: <br /> PHONE(CELL): (Home): (Work): <br /> E-MAIL(*required): FAX: <br /> I am a duly authorized agent of the applicant.As part consideration for the permission to use the above described Port of Everett facility;the applicant and I agree to <br /> comply with all Special Use Policy as set by the Port of Everett. <br /> - - . <br /> (toe - <br /> .. <br /> The applicant whereby agree to limit said activities <br /> to the specified facilities and will return the premises in a neat,clean and undamaged condition and further agree to reimburse the Port of Everett for any damage <br /> arising from the applicant's use of said facilities.The applicant Ilillbagree to abide by all lawful rules,codes,laws and regulations in connection with its use of the said <br /> premises.The applicant agree that during the use of the Ports facilities described above,we will not exclude anyone in the participation in,deny anyone the benefit <br /> of or otherwise subject anyone to discrimination because of the person's race,color,national origin,sex,religion,age or handicap.I have read and understand the <br /> foregoing. The applicant acknowledges and agrees that it shall comply with duties found in the Port's Special Use Permit,Policy Procedures and Application and that <br /> such duties are incorporated by reference in this Special Use Permit Application. <br /> APPLICANT/AGENT SIGNATURE: DATE: <br /> PORT OFFICE USE ONLY <br /> APPLICATION FEE: USE IMPACT: Low Impact O High Impact SECURITY DEPOSIT: <br /> FEES:O Water _11 Power O Security O Maintenance O Other <br /> REQUIREMENTS:CJ Parking($2/car) O Sani-cans# 0 Garbage O Permit(s): <br /> OTHER REQUIREMENTS: <br /> APPROVALS: 0 Event Team Approval 0 Signage/Marketing 0 Insurance Requirements Met <br />