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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 the specific facility /field within <br /> j the park you wish to use along with what you are asking from the Citv: <br /> Centennial Youth Hockey Association, Team B2 Red Squirts - using hockey <br /> rin for Dry-Land practice <br /> 3. What is the number of people that are involved in your event/activitti•? 18 <br /> 4. What City facilities do Vou \\ish 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 Ro Meadolwvs Park <br /> Tracie McBride Memorial Park Citv Hall <br /> 5. Please list the date or dates and times you propose to use the facilities: <br /> 10/2 2/2012 and 11/1/12 from 5:30 to 6:30 <br /> ti. 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 /> (i. e., Rand Closure(s). Temporary Liquor License(s). Fireworks Permit or <br /> Burning Permit. Use of lights. hathrooms or ports potties. Park Buildings) <br /> Please describe <br /> Depending upon the nature of \ event, or if you are requesting Cite services, you may <br /> be required complete a different application and/or make a deposit to cover city costs. <br /> Chris Reff <br /> 10/15/12 <br /> Priniq Name of Person Signing Date <br /> �4 Ad - <br /> - Signature- ---- <br /> ----------------- <br /> ------------------------------ <br /> ---------- <br /> Offi Use Only <br /> Permit approved by: Date: <br /> Deposit required: $ Receipt # <br /> Form number. 2012.04 PU <br /> I <br />