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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 /> Centennial Youth Football py4335 Pheasant Ridge DR NE <br /> Name -- _�� `� =-` ;Address <br /> 651-216-3664(Brian Sauer) ` j�? 4224-122 Blaine, MN 55449 <br /> Telephone Nu , ` City, State&Zip <br /> t <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 /> Requesting Football Practice Fields and LaMotte Park for next year(2014) <br /> Looking for fields#I and #2 on LaMotte Map <br /> 3. What is the number of people that are involved in your event/activity? 100 <br /> 4. What City facilities do you wish to use <br /> Acorn Creek Park Eagle Park <br /> Laurie LaMotte Memorial Park X Hidden Spring Park <br /> (Lighting& Warming House) Trailside Park <br /> An adult may be requested to take <br /> responsibility to lock&unlock reslraoms <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 =,J-- <br /> the facilities: <br /> August- October 2014 -5PM-8PM (j V ,�' e l 0, ; ,f, ,,, <br /> 6. is anyone charged a fee to watch or participate in your event? No <br /> 7. Have you used these facilities before? Yes 1f so,when? <br /> 2013 <br /> 8. Are you requesting additional permits or City services? Yes X 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 /> Brian Sauer 8/14/13 <br /> Printed Name of Person Signing Date <br /> Signature <br /> ■■arrrrrrrrrrrrrrrrarrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr <br /> Office Use Only <br /> Permit approved by: Date: <br /> Deposit required: $ Receipt# <br /> Form number: 2013.01 PU <br />