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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 /> Jessica Barthel 1744 Heritage Street <br /> Name Address <br /> 651-242-0000 Centerville MN,55038 <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 /> This is a 5 year old birthday party. We wish to use#5 baseball field, <br /> #6 the shelter and#I I field for games. <br /> G <br /> 3. What is the number of people that are involved in your event/activity? 30 <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) it Trailside Park <br /> An adult may be requested to take <br /> responsibility to lock&unlock resumms <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 /> August 30, 2015 1pm to 5pm <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 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 require complete a different application and/or make a deposit to cover city costs. <br /> P ,5 el �s�z/f Zags <br /> Printed Name of Person Signing Date <br /> 0-&V L4-1� <br /> Si e <br /> Office Use Only <br /> Permit approved by: Date: <br /> Deposit required: $ /oa.�° %�9� Receipt <br /> Form number: 2013.01 PU <br />