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Namel. Address/Plione Number of Individual or Organization responsible for <br />making this application: <br />Peter Sclunitt 1. 817 Prairie Dr <br />Namic <br />612 41910 8915 <br />. ................... ................................... ...... ................... - <br />Tele.pllanic.w Number <br />Adckess <br />CenterM ville—.114 550,38 <br />. ..............11 ....... ............................................................ — <br />City, Statc, & Zip <br />2. Please describeyour eventhactivity and s.,peicifiic facility/field within <br />flie park,Wu wish to use alorig wit1li wliat'yol.z argin askiiii-Ig fioni the City: <br />Centennial Youffi :Rorke would like to, use ttie LaMiotte wali.-minfz lumse and <br />.; . ...................................................................... I .... . .............................................................................................................................................................. .................................................................. I . ........................... <br />lice hiockev firl.11i i6or jaiii-actices <br />3. at is the number of people that are involved in your event/activity? 16 <br />4. at City facilities do you is to use <br />Acorn Creek Park <br />Eagle Park <br />Laurie LaMotte Memorial Park <br />Hidden Spring Park . <br />-X <br />(Lighting & Warming House) x <br />.......... <br />TrailsidePark <br />An adult may be requested to take <br />responsibility to lock & unlock restrod <br />Cornerstone Park <br />Royal Meadows Park ............. <br />Tracie McBride Memorial Park <br />City Hall <br />5. Please list the date or to and times you propose to use the facilities: <br />Janlillarv, iruilid.Febi.-aiii.i:r(,week:ni!philGs <br />6. Is anyone charged a fee to watch or participate in your event? no <br />fisju <br />7. Have you used these facilities before?-mo— If so, when? <br />8. Are you requesting additional permits or City services? — Yes x No <br />Road Closure(s), Temporary Liquor License(s), Fireworks Permit F®r <br />Burning Permit, Use of lights, bathrooms or porta-potties, Park Buildings) <br />Please describe <br />Peter Schmitt <br />Printed Name of Person Signing <br />1 ID/21/119 <br />........................................ ............................. <br />Date <br />Signature <br />M O S E S mom ME MMMM@M SUN MUM MEN MEN ME mom No ME MORE swim MMUMEMME me 8HEN NUMEM M M M E E No M M M M M <br />Office Use Only <br />Permit approved. by: 1)"atel., <br />Depositrequired: $ .................................................................................................. .............. .................................. Receipt# <br />Form numben 2013.0l.PU <br />