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OS/22/03 THU 09:58 FAX 612 784 0082 CIRCLE PINES-LEX PD ~~~ CV CITY HALL 141 0 01 Centerville Special EVCdt Permit Application 1. ~~11~i~~~~. <-b~ ~ -tptl t:M7 ~ . e~ ~ 1M' ." 1 ~ e)11~ ...t:ti.uf, Iv' at'd.it,t;~ tu:~~ W)p h.r tAu,. New Application: ~ Renewal of or Change in Application: ~ CONTACT PERSON: 12t&:t ~t?oWr t7r ~ 11j!.~- TELEPHONE: ~t:j) -b5? -//15 OR '651... b53 ..tJ,p::W IDENTIFYING INFORMATION: 2. Attach a written communicalion from the organimtion(s) in whose name the CVOllI will be advertised which a.utbori2es yon, the appl.iamt, to apply for this special event pmnit on itsltheir behalf. ~i:E1~~~ TW.: ~~U&. ~~ Affiliation: f(,h~ DayPhone: ~/-t&S~..#E Evening Phone: .$lnu.. Emergency Phone: h5l ,$)'''' '7 c,,40 3. EVENT PRINCIPALS: af! Following. please list the Dmnc=s. ad~ and telephcmc !lumbers of all the principals :involved in any ju the prcpo$Cd spcci$l cvcnL lI1c1ude professional event organizels. event proIOOters, financial underwriters, conuncreial sponsors, charitable agencies fur whose benefit the "''tnt is being produced, the organizadcm(s) in whose name the event is being advertised. and all others administratively, financial1y a.od orgaIlizationally involved as pIincipals in the production of the propo$Cd specJal event Make addi.1itmal copies of the following as needed to include as of tbc principals involved in the proposed speciall:VeI1t Name: &dtM: 1i. ;fifdd 4d Organization/Busincss/Ag cyl liation: Is this a non-profit organization? _ Yes71!r-r No IfYQU are making application under DOD-profit status. uroof of non.-mtl:fit statue must be atla.chcdJP.!b!~ a._cation Mailing Address: __; tJ f Pr Day Phone: ~ Evening Phone: Title and functional responsibility with regard to the event;