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Revised Sept. 2002 Mukilteo School District No. 6 <br /> FACILITY USE APPLICATION - GENERAL USE , • <br /> 13 <br /> USER CATEGORY: Group <br /> Nae and Address of Organization: klUg.t l frC &VC <br /> LLt4 al- -eVT,Ire.,-t± <br /> 4-tte-41 ck PwareathDc> _ -pt - L-- - -- 4s-x)3 <br /> inl <br /> Name anddress of Representative: <br /> KAX-e-Vt. CUAn2-- - t leer c ►601 J11 Y1rbb/ Areki 1 -LBO AA L ACCreCat,11 <br /> ,S)pc v-iiTte-meoc <br /> L S- a.5'7- U i- 11—b3 <br /> Business Telephone Home Telephone Date of Request <br /> K <br /> Signature of Representative Signature of Director,Student Services &Athletics <br /> Signature of Building Administrator Application Approval Date <br /> SCHOOL/FACILITY: ESTIMATED TIME TIME EVENT <br /> DATE(S) ATTENDANCE IN OUT PURPOSE: <br /> ` ` 47C-11le.m'i '(j dune, 31 - lQat2t` r6 ‘ i50 1C% <br /> At ci 113 , b'5 t '`' <br /> C. 1 ..iY 4I2.( l�C. i.Y k-DU <br /> J j <br /> SPACE REQUESTED: / <br /> l <br /> CCW6A 16( P Vt-r1oc( <br /> ( (l <br /> EQUIPMENT NEEDED: <br /> ) / -- / <br /> es�'' / <br /> 4ffji V1 <br /> ejkf t. V I t. / ( l <br /> INSURANCE REQUIREMENT <br /> REQUIRED: ❑ NO ❑ YES If"yes"is checked,proof of coverage is required prior to use of facility. <br /> Special Events Insurance is available through Mukilteo School District Business Office. <br /> USER <br /> CATEGORY COMMONS CLASSROOM GYMNASIUM KITCHEN **OUTSIDE POOL <br /> Custodial Custodial Custodial Custodial Overtime No <br /> GROUP A Overtime Overtime Overtime or*Food Service Charge S35/hour <br /> Personnel Costs <br /> $10/hr. Sink Only <br /> GROUP B $15/hour $7/hour $20/hour *$35/hr.w/Equip. $5/hour $50/hour <br /> $20/hr. Sink Only <br /> GROUP C $25/hour $15/hour $30/hour *$45/hr. w/Equip. $20/hour $80/hour <br /> 5 4 $40/hr. Sink Only <br /> $75/hour $20/hour $80/hour * <br /> GROUP D $75/hr. w/Equip. $30/hour $90/hour <br /> Custodial overtime or extra custodial needs will be assessed at the rate of$25.00 per hour. <br /> * Food Service personnel is required at an additional rate of$25.00 per hour when equipment is used. [ksh:Fac.Use) <br /> ** An additional$40.00 fee will be assessed for use of liehts. Distribution: All Copies to Student Services/Athletics Dept. <br />