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PARK FACILITY PERMIT APPLICATION <br /> <br />1. Name/Address/Phone Number of Individual or Organization responsible for <br />making this application: <br />P.O. Box 356 <br />Peter Schmitt on behalf of C <br />_______________________ _________________________ <br />Name Address <br />612-490-8915Circle Pines, MN 55014 <br />_______________________ _________________________ <br />Telephone Number City, State & Zip <br /> <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 />Once ice is on the outdoor rink at LaMotte, Centennial Youth Hockey would <br />_________________________________________________________________ <br />like to use the full rink and warming house. I ask that Centerville attempt to <br />_________________________________________________________________ <br />flood the rink for ice as soon as possible. I this ask is weather dependent. <br />_________________________________________________________________ <br /> <br />16 <br />3. What is the number of people that are involved in your event/activity? ________ <br /> <br />4. What City facilities do you wish to use <br /> <br />Acorn Creek Park _____ Eagle Park _____ <br />x <br />Laurie LaMotte Memorial Park _____ Hidden Spring Park _____ <br />x <br /> (Lighting & Warming House) _____ Trailside Park _____ <br />An adult may be requested to take <br />responsibility to lock & unlock restrooms <br />Cornerstone Park _____ Royal Meadows Park _____ <br />Tracie McBride Memorial Park _____ City Hall _____ <br /> <br />5. Please list the date or dates and times you propose to use the facilities: <br />Monday - Thursday, 6-7 pm January 2nd- March 3rd, 2023 <br />_________________________________________________________________ <br /> <br />NA <br />6. Is anyone charged a fee to watch or participate in your event? _______________ <br /> <br />Yes <br />7. Have you used these facilities before? ______ If so, when? <br />January - February 2021 & 2022. <br />__________________________________________________________________ <br /> <br />X <br />8. Are you requesting additional permits or City services? _____ Yes _____ 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 /> <br />Please describe __________________________________________________________ <br /> <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 /> <br />_________________________________ __________________ <br />Printed Name of Person Signing Date <br /> <br />_________________________________ <br /> Signature <br />Office Use Only <br /> <br />Permit approved by: __________________________ Date: __________________ <br /> <br />Deposit required: $______________ Receipt # _______________ <br />Form number: 2013.01 PU <br /> <br />