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PARK FACILITY PERNIIT APPLICATION <br /> 1. Name /Address/Phone Number of Individual or Organization responsible for <br /> making this application: <br /> Centennial Soccer club <br /> Chris Melmer /612- 616 -7082 <br /> 2. Please describe your event/activity and identify the specific facility/field within <br /> the park you wish to use along with what you are asking from the City: <br /> Summer soccer practices for the age group 9/10 <br /> 3. What is the number of people that are involved in your event/activity? 10 -15? <br /> 4. What City facilities do you wish to use <br /> Acorn Creek Park Eagle Park <br /> Laurie LaMotte Memorial Park Hidden Spring Park <br /> (Lighting & Warming House) — Trailside Park <br /> Cornerstone Park Royal Meadows Park <br /> Tracie McBride Memorial Park _ City Hall <br /> 5. Please list the date or dates and times you propose to use the facilities: <br /> Sunday - Thursday between the hours of 5 and 9PM. Precise schedule will follgs <br /> 6. Is anyone charged a fee to watch or participate in your event? No <br /> 7. Have you used these facilities before? ❑ If so, when? <br /> 8. Are you requesting additional permits or City services? C Yes IS No <br /> (i.e., Road Closure(s), Temporary Liquor License(s), Fireworks Permit or <br /> Burning Permit, Use of lights, bathrooms or porta potties, Park Buildings) <br /> Please describe <br /> Depending upon the nature of your event, or if you are requesting City services, you may <br /> be required complete a different application and/or make a deposit to cover city costs. <br /> Chris Melme 04/05/2012 <br /> Prim Name; N rson Signing Date <br /> Signature <br /> Office Use Only <br /> Permit approved by: Date: <br /> Deposit required: $ Receipt # <br /> Form number: 2012.01 PU <br />