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Application for Special Event Permit- Temporary Road Closure Addendum (2)

2. Disclosure
   <b>Event Notification and Communication</b>- Event sponsor (applicant) will be responsible for contacting all individuals, residents, and businesses who will be impacted by the event's temporary road closure(s). The Town of Fuquay-Varina requires an event sponsor to provide written notice certifying that all adjacent business owners of the public street(s) subject to closure in relation to the planned event have been notified to the temporary road closure(s).

   Event Notification and Communication- Event sponsor (applicant) will be responsible for contacting all individuals, residents, and businesses who will be impacted by the event's temporary road closure(s). The Town of Fuquay-Varina requires an event sponsor to provide written notice certifying that all adjacent business owners of the public street(s) subject to closure in relation to the planned event have been notified to the temporary road closure(s).

6. Affidavit of Applicant
   My Signature below indicates that everything I have stated in this application is correct to the best of my knowledge. I have read, understand and agree to abide by the policies, rules and regulations of the Town of Fuquay-Varina as they pertain to my request. The permit, if granted, is not transferable and is revocable at any time at the absolute discretion of the Town of Fuquay -Varina's Town Manager's Office (or designee). My signature below indicates consent to any inspection by any Town staff member. All programs and facilities of the Town of Fuquay-Varina are open to all citizens regardless of race, sex, age, color, religion, national origin, or disability.

   My Signature below indicates that everything I have stated in this application is correct to the best of my knowledge. I have read, understand and agree to abide by the policies, rules and regulations of the Town of Fuquay-Varina as they pertain to my request. The permit, if granted, is not transferable and is revocable at any time at the absolute discretion of the Town of Fuquay -Varina's Town Manager's Office (or designee). My signature below indicates consent to any inspection by any Town staff member. All programs and facilities of the Town of Fuquay-Varina are open to all citizens regardless of race, sex, age, color, religion, national origin, or disability.

8. Applicant's Signature

   By typing your name into this field, you authorize that Town of Fuquay-Varina to consider this an electronic signature.

9. Date
   Date

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11. 1. Receive an email copy of this form.
12. Email address

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