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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 />227 Galaxy Dr <br />Brian Olson <br />_______________________ _________________________ <br />Name Address <br />763-245-9605Circle 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 />Rocket Launch at Laurie LaMotteMemorial Park. Last year we set up just off <br />_________________________________________________________________ <br />the parking lot and that worked great. <br />_________________________________________________________________ <br />_________________________________________________________________ <br /> <br />30 <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 /> (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 />5/4/224 and 5/11/24 as a backup <br />_________________________________________________________________ <br /> <br />No <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 />Anually at the same time. <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 />Brian Olson3/8/24 <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 />