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PARK FACILITY PERMIT APPLICATION <br /> 1. Name /Address/Phone Number of Individual or Organization responsible for Ni ii ' N <br /> making this application; <br /> 1 ji nn lzP. L¢73iLarI Rile 5 <br /> a.f Address 3 <br /> .0S 351 - 3a13 l� n nim ss $ <br /> elep one Number City; State & Zip p t ., <br /> 04 <br /> 2. Please describe your event/activity and identify the specific facility /field within S <br /> the park you wish to use along with what you are king from the City: ),,. ,1 <br /> 1 kelti I nq in t}rdrm 5prin r.K- f.JP U'u1!31 <br /> j i ts-1- I i k . e L 11 ' ,5e jxzrK si rrr e iuir a:in5 q - rwr. }/AL Nit <br /> 3. What is the number of people that are involved in your event/activity? u <br /> /a Oe6, <br /> 4. What City facilities do you wish to use o <br /> Acorn Creek Park Eagle Park <br /> Laurie LaMotte Memorial Park Hidden Spring Park <br /> (Lighting & Warming House) Tmilside Park <br /> Cornerstone Park Royal Meadows Park <br /> Tracie McBride Memorial Park 0 City Hall <br /> 5. Please list the date or dates and times you propose to use the facilities: <br /> I... I _I• — I� <br /> u <br /> 6. Is anyone charged a fee to watch or participate in your event? no <br /> 7. Have you used these facilities before? no If so, when? <br /> 8. Are you requesting additional permits or City services? Yes ,/ No <br /> (Le., 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 /> L1 <br /> nn () )e42r,t Date <br /> Printed Name of Person Signing <br /> Ol .II As . $/.A. , <br /> i <br /> Si: 1 ture <br /> Office Use Only <br /> Permit approved by: Date: <br /> Deposit required: $ Receipt # <br /> Fonn number: 2012.04 PU <br /> 13 <br />