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WASHINGTON STATE PARKS&RECREATION COMMISSION Office Use Only:
<br /> age
<br /> a. Commercial Use Permit/ Permit No.
<br /> Annual ❑ Vendor ❑
<br /> Temporary Vendor Permit & Application Vendor Dates:
<br /> A non-refundable$50 permit fee and proof of insurance must accompany this application. Permit may take up to 30 days
<br /> to process. Business activity cannot take place until approved CUP is returned by State Parks and received by applicant.
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<br /> Business Name City of Everett Parks Doing Business As(DBA) UBI or Business License Number(required)
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<br /> 2_,Contact irjta"rirnat'Iofar <
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<br /> Contact Person/Title Euan Robertson,Recreation Supervisor Field Contact(if different)
<br /> Mailing Address 802 E Mukilteo Blvd City Everett State WA Zip 98203
<br /> E-Mail Address erobertson@everettwa.gov Business Telephone Number:425.257.8396 Cell Phone Number:425.512.4277
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<br /> Please
<br /> 3.:�4ctli les.;P Pennon actNrty, ddr�� rial terms PI:anco12941.9,Uymay°aRply_,^T, _ VS
<br /> Please list activities that will be conducted. Attach additional sheet for itineraries,trips,maps,etc.(example:bicycle tours with detailed itineraries). Our
<br /> department offers a variety of walks,hikes,cross country skiing snowshoe and bike trips throughout the region. All activities are day trips and spend
<br /> two to six hours in parks.
<br /> How many times per year will this activity take place?Twelve Average size group?Twelve
<br /> ;:4_:,Par�'S�ul/ashm onS#ate Parks has#�er,�ght�toaimri�se,or fortii�certain,ac�avitie�fromitakingplace atspeafic.parks ,z,a4.:.,�: w.�.�.�.:_�'�'���=, �.�;.�;
<br /> Please list parks where activity will take place:Rasar,Rockport,Larrabee,Deception Pass,Lake Wenatchee,Lake Easton,Iron Horse.
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<br /> tg9nporai y Vendors This section appliesflnlyzto temporary vendors panc9patingrwith02special event `7f ri " , h0,04
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<br /> Dates of Event Items for sale Will alcoholic beverages be sold? Yes 0 No 0
<br /> If yes,additional terms will apply.
<br /> Permittee Acknowledgment: I attest that the information submitted on this form and any attachments are true,complete,and accurate to the
<br /> best of my knowledge. By signing this form,the permittee,its agents and employees agree to conduct the authorized activities under this permit in
<br /> accordance with the attached terms and conditions and any special terms that are incorporated upon the issuance of this permit. Any violation of the
<br /> terms and conditions or false information presented may be grounds for revocation of this permit.
<br /> Signature of Permittee Date
<br /> Office Use Only: ;Accounting i, ,Y M, N ` M _ .
<br /> Date: C1#or CC# Amount Paid:
<br /> Approved Approved with Changes Additional Terms Denied
<br /> End of Season:
<br /> Signature of Authorized State Representative Date of Issyiance
<br /> P&R 0-341(11/2016) o
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