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Home My WebLink AboutSpecial Event ApplicationJefferson County Special Event Application: 1.10.22 Page 1 of 4 Executive Assistant Adiel McKnight Phone: 360-385-9102 1820 Jefferson Street Fax: 360-385-9382 P.O. Box 1220 Email: jeffbocc@co.jefferson.wa.us Port Townsend, WA 98368 Jefferson County Special Event Application This application must be completed, signed, and forwarded to the Jefferson County Administrator at least ninety (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. 1. Event Event Name: __________________________________________________________________________ Event Type: Exhibition (EX) ____ Race (RA) _____ Ride (RI) _____ Musical Event (ME) ______ (check one) Parade (PA) _____ Walk (WA) _____ Festival (FE) _____ Run (RU) ______ Dance (DA) _____ Drama (DR) _____ Other (OT): Specify___________________________ Event date(s) _______________ Day(s) of the Week _____________________ Time(s) OPEN and CLOSE each day________________________________________________ Event Location ________________________________________________________________________ Facilities to be used (check): Park ______ Street _______ Sidewalk _______ Private Property _________ Set up times: Begin: _____________________am/pm Dismantle: _________________________ am/pm Purpose of Event: ______________________________________________________________________ Event Crowd Size: Participants __________ Spectators __________Volunteers/Personnel ____________ Has this event been produced previously? Yes ___ No ___ If yes, what were the dates _______________ Any change from previous events? Yes ___ No ___ If yes, list changes for this year’s request: ___________________________________________________ 2. Applicant Information Organization Name:____________________________________________________________________ Mailing Address and Zip Code:___________________________________________________________ Applicant’s Name ____________________________________Title _____________________________ Phones #(s): Home: ________________________ Work: ______________________________________ Cellular: _____________________ Email: _________________________________________________ Contact Person: _______________________________________________________________________ Jefferson County Special Event Application: 1.10.22 Page 1 of 4 Phones #(s): Home: ____________________________ Work: __________________________________ Cellular: __________________ Email: _____________________________________________________ Event Name: __________________________________________________________________________ 3. Exemption Request Are you requesting exemption from the special event fees? Yes _____ No _____ State the reason for the exemption (e.g. constitutionally protected, etc.) ___________________________ 4. Fees and Proceeds Admission Fee: (Check one) Yes _____ No _____ If yes, how much? _________________________________ Any vending or sales: Yes _____ No _____ If yes, check all that apply: Books _______ Balloons ___________ Other: Specify ______________________________ Beverage _____ T-shirts/Hats ________ Buttons ________ 5. Food Food Yes_____ No _____ Food Vendors Yes_____ No_____ Food Provided at no cost Yes _____ No_____ ** If yes please list them _____________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Does the event involve food service, either food vendors or food or drink provided for free? If yes, the applicant MUST contact Jefferson County Public Health a minimum of 2 weeks prior to the event to verify if a permit is required. All food vendors must apply for a Temporary Food Service Permit unless already permitted as a mobile unit. All must be reviewed and approved by Jefferson County Public Health. 6. Entertainment and Promotions Sound System: Acoustic ____________ Amplified ___________ Describe entertainment: _____________________________________________________________________________________ _____________________________________________________________________________________ List of entertainers or bands performing at event: _____________________________________________________________________________________ _____________________________________________________________________________________ Check type of promotion you plan to use to attract participants: TV _________ Radio _________ Newspaper _________ Billboards ___________ Posters ___________ Flyers _______ Other: Specify ___________________________________________________________ Have local neighborhood groups or businesses approved your event concept? Yes ________ No _______ If no, what steps will be taken to notify them of your event ____________________________________________________________________________________ List community contacts and phone numbers (for verification) or attach an approval letter: Name: _______________________________________________Phone # _________________________ Name: _______________________________________________Phone # _________________________ Jefferson County Special Event Application: 1.10.22 Page 1 of 4 7. Special Set-Ups Requested Check appropriate category below and fill in details on numbers, size and type. Leave blank if not applicable. a. Animals ____________ How many __________ Species ____________________________________ b. Booths _____________ How many __________ Where _____________________________________ c. Commercial Signs _____ How many __________Size ______________________________________ d. Electricity Source _____ Generators __________ How many _________________________________ e. Fireworks _________ Ground ______ Aerial _______ Fireworks Company ______________________ f. Portable Restrooms _____ How many ____________ Handicapped accessible ____________________ g. Hand Washing Station Yes __________ No ____________ if Yes How many____________________ h. Water _______ Potable ____________ Non –Potable _______________________________________ i. Rides ________ How many __________ Type _____________________________________________ j. Staging/Scaffolding _______ How many __________ Height _________________________________ k. Tents/Canopies _______ How many __________ Size ______________________________________ l. Vehicles _______ How many __________ Type ____________________________________________ m. Noise Variance _____ No ____ Yes ______ If yes, $100 permit fee required. Basis for variance request and hours _______________________________________________________ Event Name: __________________________________________________________________________ 8. Public Safety a. 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 b. What are your plans for on-site security, monitors, and route control? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ c. What are your plans for medical assistance? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ d. Discuss your parking plans for participants and spectators. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Jefferson County Special Event Application: 1.10.22 Page 1 of 4 _____________________________________________________________________________________ e. List any additional information which the Special Event Committee may find reasonably necessary for a fair determination of whether a permit should be issued. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 9. Insurance Information – Provide a copy Name of Insurance Agent _______________________________________________________________ Address ______________________________________________________________________________ Phone _________________________________________Contact Person _________________________ Name of Insurance Company _____________________________________________________________ Policy Number __________________________ Will liquor be served at this event? Yes _____ No _____ Jefferson County Special Event Application: 8.10.12 Page 4 of 4 Event Name: __________________________________________________________________________ 10. Garbage and Recycling Are you providing garbage and recycling containers? Yes _____ No _____ If yes, please describe: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 11. Traffic Control Plan 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. Traffic Control Specify if Monitor, Flagger, or Police Officer Location Duties