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2. Disclaimer

   This form is to be completed by the Requestor and must be submitted ten working days prior to the event. Requestor will be notified via telephone of approval or denial. 

4. Date*
   Date
6. Location of Street Closure *

   Please specify the boundaries of the street closure. For example: Vance Street from 35th to 36th. 

8. The Street will be barricaded at *

   Please specify where you need the barricades. For example: The end of the street at 35th and 36th 

10. Date of Event*
    Date of Event
11. Start time of event*
    Start time of event
12. End time of event*
    End time of event
14. Please provide a brief explanation of the event*
16. Please select which option describes your event*

    1. Neighborhood Function only
    2. Private Function with neighborhood consent (birthday, wedding, shower, etc.)
20. Contact Information

    An individual who can be contacted before, during, and after the event

22. First Name*
23. Last Name*
25. Address*
27. City*
28. Zip Code*
29. Phone Number*
31. Email Address*
35. Requestor Information

    1. Check if same as above
37. First Name
38. Last Name
40. Address
42. City
43. Zip Code
44. Phone Number
46. Email Address
50. Requestor Acknowledgement

    Requestor accepts responsibility for this event and ensures that ordinances and codes of the City of Wheat Ridge and the State of Colorado are adhered to. Requestor shall also ensure accessibility to emergency vehicles through the area of the event.

52. I have read and understand the Requestor Acknowledgement statement above*

    1. Yes
54. Name *
55. Date
    Date
Leave This Blank:


57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit

* indicates a required field