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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 /> Chris Reff 1050 Black Duck Ct <br /> Name Address <br /> 651 -653 -7723 Lino Lakes, MN 55014 <br /> Telephone Number City. State & Zip -- <br /> 2. Please describe your event/activity and identify dentifiy the specific facility /field within <br /> the park you wish to use along xvith what you are asking from the City: <br /> Centennial Youth Hockey Association, Team B2 Red Squirts - using hockey <br /> ring for Dry-Land p ractice <br /> 3. What is the number of people that are involved in your P event/activity? 18 <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 /> Comerstone Park Royal Meadows Park <br /> Tracie McBride Memorial Park ja_ City Hall <br /> 5. Please list the date or dates and times you propose to use the facilities: <br /> 10/22/2012 and 11/1/12 from 5:30 to 6:30 <br /> 6. Is anyone charged a fee to watch or participate in your event? No <br /> 7. Have you used these facilities before? Yes If so. when? <br /> Last year, similar use however I wasnt the person reserving space <br /> 8. Are you requesting additional permits or City services? Yes No <br /> (1. 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 /> Chris Reff 10/15/12 <br /> Printed Name of Person Signing Date <br /> Signature <br /> Office Use Only <br /> Permit approved by: Date: <br /> Deposit required: $ Receipt # <br /> Form number. 2012.04 PU <br /> -t7 <br />