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PARK FACILITY PERMIT APPLICATION <br /> 1. Name /Address/Phone Number of Individual or Organization responsible for \ 4 . -- • <br /> making this application <br /> Lj Lod 6213g Or" Ave. S - <br /> Address <br /> S 351 - ?) 13 n J'11.n1 : 5 �03R R .(' <br /> Telep one Number City; S tate & Zip p - <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 . king from the City: ,,0 <br /> We d ■ n I r\ (+i dd er ri n rK - We- ! 10 <br /> 3. What is the number of people that are involved in your event/activity? /p0 f.t,e6 <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 /> CLU5v5 aS, Dia op P m - 5: 30 pm <br /> 6. Is anyone charged a fee to watch or participate in your event? I\ D <br /> 7. Have you used these facilities before? n o if so, when? <br /> 8. Are you requesting additional permits or City services? Yes ZNo <br /> (i.e., Road Closure(s), Temporary Liquor License(s), Fireworks Permit or <br /> Burning Permit, Use of lights, bathrooms or ports 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 /> t nn ( )e +Le.) 5 l i l i a <br /> Printed Name of Person Signing Date <br /> ( A- ) Litj <br /> Si ture fbfrlid <br /> Office Use Only <br /> Permit approved by: Date: <br /> Deposit required: $ Receipt # <br /> Form number. 2012.04 PU <br />