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2. Do you need a special event permit?

   Please answer the following questions to determine if your event will require a special event permit. Allow a minimum of 5 full business days for staff to review the pre-application and determine if a permit is required. Subsequent documents may be needed if a permit is required. Applications must be submitted not less than thirty (30) calendar days prior to the proposed start date of the special event.

4. GENERAL INFORMATION
6. Event Title/Name*
8. Event Sponsor/Producer*
10. Event Producer Address*
12. City
13. State
14. Zip Code
16. Business Phone*
17. Email Address*
19. Event Website URL
21. City
22. State
23. Zip Code
25. Name & title of authorized event organizer/planner/contact (if different from above)
27. Address
29. City
30. State
31. Zip Code
33. Business Phone
34. Cell Phone
35. Email address
37. EVENT DETAILS
39. Type of Event*

    1. Block Party
    2. Walk/Run/Bike
    3. Outdoor Concert

    1. Parade
    2. Festival

    1. Farm or Automotive Show
    2. Other
41. If other, please explain
43. Event information*

    Please check all that apply.

    1. Private event (invitation only)
    2. Public event
    3. Held on private property
    4. Held on public property
    5. Partial or full closure of a public street
    6. Blocking or restricting access to private or public property
    7. Use of pyrotechnics or special effects
    8. Use of open flame or other potentially dangerous displays

    1. Sale or distribution of merchandise
    2. Mobile food vendors
    3. Alcohol sales
    4. Tent(s) or canopy
    5. Installation of a stage, bandshell, truck, trailer, van, portable building, booth, grandstand or bleachers
    6. Placement of temporary signs or banners
    7. Amplified sound
    8. Attendance of 500+ at one time
45. Estimated event attendance*
46. Estimated peak attendance*
48. Please include a detailed event map*
49. Please specify what you're installing as noted above
51. If you're placing temporary signs/banners, when would they be posted?
52. If you're erecting a tent or canopy please specify size (square feet) and type

    Number of tents/canopies? Enclosed side walls? Top protection?

54. Event Facility/Venue*
56. Facility/Venue Address*
58. City
59. State
60. Zip Code
62. Date(s)/Time(s) of Event*

    Please include details of when the event will take place and when event set-up/take-down and cleanup will occur. If you have an alternate date/time the event could take place, please include that information as well.

64. Event Description*

    Please include a detailed description of the event and planned activities.

66. ACKNOWLEDGEMENT
68. Notice of City Code

    Chapter 11 of the Ankeny Municipal Code prescribe the conditions through which special events of limited duration may be permitted to occur within the City that involve a request from an individual or organization creating an anticipated significant impact to City property or right-of-way, such as increased vehicle or pedestrian traffic or the closure of a public street, and it is advisable or necessary to include City staff in the preparation, planning, coordination, and approval of the requested special event to promote the health, safety and welfare of the general public and of the event participants or attendees.

70. Certification*

    I certify that all information in this application and the required documents is true and correct to the best of my knowledge, and upon submittal becomes public record. I understand that any missing documentation may delay license approval. I further understand that should I commit a violation of the terms and conditions of this license, my license may be revoked. I agree that I will obtain any other permits necessary and will follow the guidelines and requirements set forth in Chapter 11 of the City of Ankeny’s Municipal Code and on the list of requirements provided to me.

    1. I agree.
72. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
74. Electronic Signature*
Leave This Blank:


76. 1. Receive an email copy of this form.
77. Email address

    This field is not part of the form submission.

78. Submit

* indicates a required field