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va L'+ i 11.):4oa nisuga►e, inc. 651- 204-9077 p,1 <br /> PARK FACILITY PERMIT APPLICATION <br /> 1. Name/AddressfPhone Number of Individual or Organization responsible for <br /> making this application: <br /> Christi Schreyer 6782 E. Shadow Lake Dr <br /> Name Address <br /> 651 -407 -8169 Lino Lakes, MN 5501 <br /> Telephone Number City, State & Zip <br /> 2. Please describe your even /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 /> Use hockey rink for dryland training for cyha C Squirt team. <br /> 3. What is the number of people that are involved in your event /activity? 16 <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 /> 10/27/12 @11 a.m. <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 /> (i.e., Road Closure(s), Temporary Liquor License(s), Fireworks Permit or <br /> Burning Permit, Use °f lights, lights, bathrooms or ports potties, Park Buildings) <br /> Please describe NO <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 /> Christi Schreyer 10/24/12 <br /> 'rin . • : i, ofPcr Signin Dat <br /> I/1 <br /> Signature <br /> Office Use Only • <br /> Permit a .1' roved . - - -Ii ILIO - .,_,‘ Q Date: 1041-//,Z. Deposit required: $ A Receipt # /t/ //9" <br /> Form number: 2012.04 P15 <br /> ` )).-ef-et...ka..__ -Ee-C=,2 r <br />