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<br />05/22/03 THU 10:02 FA! 612 784 0082 <br /> <br />CIRCLE PINES-LEX PD <br /> <br />~~~ CV CITY HALL <br /> <br />III 006 <br /> <br />DAYt DATE AND TIME: <br /> <br />1. PARKS AND RECREATION DEPARTMENT <br />FlNAL APPROV AI..AND SIGN OFF <br /> <br /> <br />Centerville <br />Spedal Event Permit <br /> <br />Signature <br />Date: <br /> <br />Title <br /> <br />Please check or use NJA (not applicable) where appropriate: <br />1. _ Final check has been made of application requirements. <br />2. _ Event is approved by City CounciL <br />3. _ All required permits are issued and on file. <br />4. _ Refundable clean up fee has been paid. <br />S. _ Insurance Certificate is on file with City Clerk <br />6. _ Surety Bond is on file to secure payment for applicam's obligation to the <br />City. <br />7. _ Application is complete. <br />8. _ Special conditions arc attached. <br /> <br />REVOCATION: Upon mutual consent, the City Council may revoke a. special event permit If <br />the conditions set fourth in the permit application are not being followed. <br /> <br />Permit is hereby revoked: <br /> <br />Signature <br /> <br />Title <br /> <br />Date: <br /> <br />Reason(s) for revocation: <br /> <br />TO BE REVIEWEDI APPROVED AND SIGNED BY AFFECTED <br />CITY DEPARTMENT HEADS <br />