HomeMy WebLinkAboutpermit to use parkJun-16-04 00145am From-
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T-T06 P.02/02 F-818
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iNISTRUOT1ONS: An application for Permit must be filed with the Dopanment0 Parks and Recreation at least ten (10) days in
advance of the specified date of an event-
_ _.._._.. orison2. Glry Resident,.Rsold��3. Prom of Ra9tdertGy: lTYpa at 1.13,):
1. Name oil ❑ YES CI NO
City of Miami
APPLICATION FOR
PERMItit USE PARK FACILITY
Parks and Recreation
Permits aection.-..*..,.
444 SW 2nd Ave.
(305) 418-1322
k Mailing Address'
. f
r,'r .r ,+'rxJ .'��irr/•ch' ;"6: Ii'7i,,,rcf ..'.rf. #.f4i/r,//_.5. /;.
1. Home Telephone No.; 'S. Sponsor Status
•...:} - • C, `:if+;.0 7 11. f=acuity Applied For:
10, Park Nere:
1 a. Type of Event: 10. Dete(s) of Event y() at Weak:. K `r
17. Grade/Age Leval ofof 18. Will food and/Dr beverages be served
PartioIpants: . • at the event? .• ' ' G3 YE6 4 NO
S. Contact Pericn:
hi'/di i^0..5 •4'1r1Z. 23Z
s. Tact 4empt No.:
8, Warts Telephone No.:
15. Hours of Event: 18. Projected NQ. of
From: $ i - Mai To: s ppi. 4 Partialpants:
19. Will alcoholic beverages be served?
U YES 1;1'NO (Specify)
so, Special Requirements Needed:
21, Q Proof of inEEuranoa Attached 0 Provision of insurance is not iippltcablo
THIS IS AN APPLICATION FOR PERMIT ONLY. CONPiRMATION OF THIS REQUEST IS THE ISSUANCE OF
THE "OFFICIAL PERMIT UPON PAYMENT OF FEES. PAYMENT FOR PERMITS IS TO BE MACIE BY
CASHIER'S CHECK OR MONEY ORDER ONLY, AND IT 1S TO BE MADE OUT TO THE ORDER OF "THE
CITY',OF MAW. CASH IS NOT ACCEPTED UNDER ANY CIRCUMSTANCE. THE DEPARTMENrT.OF PARKS
?—AND RECREATION RESERVES THE RIGHT TO CANCEL. ANY PERMIT FOR CAUSE.
The above -named school, organization, or sponsor is fully cognizant of their responsibility in connection with the
use of the above -named facility, and agrees to observe, obey, and comply with all City o3 Miami Department of
Parka and Recreation Ruies and Regulations, as well an all City, County, State, and/or Federal laws, ride®, and
regulations, I, the undersigned appiloant, hereby acknowledge receipt of a oopy of "City of Miami Department of
Parks and Recreation, Rifles, Regulations, and Permits", Ordinance No. 7999 and Fee Schedule.
INDEMNIFICATION:
Permlttee shall indemnity and save CITY Karl -Ness from and against any and n11I claims, liabilities; losses, and
cause of action, which may arise out of permltteo's activities under this Agreement, including all other aote or omis-
sions to act on the part of peerm)ttee, including any person acting for or on his/her behalf and, from and agaIrtat any
orders, judgements Or decrees which may bee.sntered, and from and against all wets, attorney's tees, expenses
and liabilities incurred In the defense, of Sty such claims, or in the Investigation thereof,
w•
tore of Applicant
FOR ARKS AND RECHEATI RI DE)ARTmIENT tip ONLY
Prepared ay:
Facil)ty..Rentai Fee: $' Subtotal: $
Set-up Fee: $- — , Tax: : " $—
i
• Staff Fee:
0 PR/PA 201 RN. 11/00 .
Authorised Signature
Permit No.:
�rrfl.
Total Charges: • 'erge Date; ,. -
1 DisMution: White.- Applfiant; annoy - Adminiprrativ* Was: Pink - Park Sits Office.
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