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PARK FACILITY PERMIT APPLICATION <br /> 1. Name /Address/Phone Number of Individual or Organization responsible for <br /> making this application: <br /> Vort'SS& CoCkreth )43g f i view Grclt <br /> Name Address <br /> (.5t 283 (01-1(02. I .e no (ylkts M1u 550ar <br /> Telephone Number City, State & Zip <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 /> tt pt. v MI 0 S L4/I P l 1'' ' ' 'f <br /> 3. What is the number of people that are involved in your event/activity? r2- <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 _El_ City Hall <br /> 5. Please list the date or dates and times you propose to use the facilities: <br /> c1/22/11- 11 :30.3:00 <br /> 6. Is anyone charged a fee to watch or participate in your event? 14 <br /> 7. Have you used these facilities before? /Y0 If so, when? <br /> 8. Are you requesting additional permits or City services? Yes 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 /> Va nessa CoshrurM <br /> Printed Name of Person Signing Date <br /> vittret, <br /> Signature <br /> Office Use Only <br /> Permit approved by: Date: 91/2/A17,___ <br /> Deposit required: $ /O. p6 Receipt # ff/ 7 <br /> Form number: 2012.04 PU <br />