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O <br /> Agreement# <br /> EVERETT PUBLIC SCHOOLS <br /> REQUEST TO USE SCHOOL FACILITY <br /> (A copy of this form and applicable fees can be obtained from www.everert.k 12.wa.us) <br /> a y .gam <br /> C11t 011, LU: 1 ma ><t 1 <br /> NAME OF EVENT I�fi12✓'e, 19v-btt L t'JYdt q Y► iii iYr� &eta C42Vei44-o►A�/ <br /> NAME OF GROUP USING FACILITY O e ,rY 4-t— A(,L <br /> EVENT CONTACT PERSON p Co A-1,l. VVl k ; • <br /> PHONE (day)47h CSo30 (este) E-MAILS t(h 4SLA_; ezci.-e vete-1-1-, wet.to <br /> MAILING ADDRESS a•-;74:),- 1+ Pt-u e CITYg-ve•,e t'{- STATE t,)Y- ZIP ('T-20/ <br /> For Tickets Call: Tom) it Box office opens at: Tickets Priced S to S <br /> Curtain/Meeting start time(s): Expected attendance:#adults¢W #youths2actotal (1 00 <br /> SPONSOR(IF DIFFERENT FROM ABOVE) <br /> *BUILDING ADMINISTRATOR SIGNATURE(for School Use Only) <br /> *Signature indicates school/district sponsored event. <br /> Scneda�le f <br /> STARTS DAY OF WEEK 1 I�u rS dal n DATEA11u5I") ZCOG **TIME q— (1 /�-4 5e 4 p <br /> ENDS DAY OF WEEK I DATE **TIME Co t-,fo.tty\ <br /> If weekly,list dates: <br /> **Time:list time staff is to open door,and time last user will leave building <br /> "165,. nxw 3C.x , t .y .g s �, - y <br /> t _i mod. /�� ' v-c*`"' _�il ulld Olh '3 <br /> 1.046, <br /> Cascade High School Library y 1,552 occupant load <br /> _Everett High School Faculty Lounge 1,496 occupant load <br /> —Jackson High School Classroom with orchestra area cleared. <br /> _Sequoia High School Cafeteria/Commons <br /> Eisenhower Middle Kitchen--[see back; 441 Person answering phone during event <br /> _Evergreen Middle Tennis courts <br /> _Gateway Middle Main Gym Menional Stacituri /Lincoln Fie If <br /> Heatherwood Middle Aux.Gym "" <br /> _North Middle Track Memorial Stadium Track/Football Facility <br /> _Cedar Wood Elem. Locker Room <br /> Emerson Elem. Field**Type ii.e.,football] Memorial Stadium Baseball Facility <br /> Garfield Elem. ** Memorial Stadium Practice Field(grass) <br /> Hawthorne Elem. ** Memorial Stadium Locker Rooms <br /> Jackson Elem. ** Lincoln Field Soccer/Track <br /> Jefferson Elem. ** Lincoln Field Softball <br /> Lowell Elem. Lincoln Field Concession Stands <br /> Madison Elem. <br /> —Mill Creek Elem. <br /> Monroe Elem. Services(pending availabilitya f , c '• <br /> st F <br /> Penny Creek Elem. <br /> Silver Firs Elem. Qty Item Qty Item <br /> Silver Lake Elem. Podium Piano <br /> I Table Sound Shell-Auditorium only <br /> —View Ridge Elem. <br /> Whittier Elem. g, Microphone Band Riser-Auditorium only <br /> 3 Chair o n Sia u Other**(i.e.stadium lights,etc.) <br /> —Woodside Elem. Marley Floor J ** <br /> —Lively Enviro.Ctr <br /> (Auditorium only.585.00 fee per use.) <br /> SfaffUse Only For Office Use Only: <br /> Facility Cleared By <br /> Book User Confirm Copy <br /> Principal Custodian Secretary <br /> Maintenance Chrono <br /> Other <br /> Custodian.Use Only Invoice#: Priority#: <br /> Custodian Date certification form was received: <br /> Time User In Out #Attend Insurance <br /> Equipment Used <br /> Damage <br /> 4 <br />