WA State Parks and Recreation Commission 12/29/2016

CITY ,..,„,ntt„t,_, WASHINGTON STATE PARKS& RECREATION COMMISSION Office Use Only: Permit No. 207--/70o iiii$ Commercial Use Permit / Annual Vendor ❑ Temporary Vendor Permit & Application Vendor Dates: A non-refundable$50 permit fee and proof of insurance must accompany this application. Permit may take up to 30 days to process. Business activity cannot take place until approved CUP is returned by State Parks and received by applicant. 1. Business Information Business Name Doing Business As(DBA) I UBI or Business License Number(required) . Everett Parks and Recreation i 91-6001248 2. Contact Information Contact Person/Title Field Contact(if different) Jane Lewis, Recreation Supervisor Mailing Address City State Zip 802 E Mukilteo Blvd Everett WA 98203 E-Mail Address Business Telephone Number: Cell Phone Number: jlewis@everettwa.gov 425-257-8369 425-879-2952 3. Activities Depending on activity,additional terms and conditions may apply Please list activities that will be conducted. Attach additional sheet for itineraries trips,maps,etc.(example:bicycle tours with detailed itineraries). Snowshoeing triadditional skiing trips,Walking and Hiking, All are day trips and we will be on the property a total of 2-6 hours per trip, with approximately 8-11 people per trip. How many times per year will this activity take place? Approximately 6-10 times, total all trips combined_ 4. Parks Washington State Parks has the right to limit use or forbid certain activities from taking place at specific parks. Please list park(s)where activity will take place: Lake Wenatchee, Iron Horse, Deception Pass, Tiger Mountain,Dagualla, Federation Forest, Fort Ebey,Olallie,Wallace Falls,Camano, Cama Beach, Palouse Falls, Larravee, Ginko. 5. Temporary Vendors This section applies only to temporary vendors participating with a special event. Dates of Event Items for sale Will alcoholic beverages be sold? Yes El No❑ If yes,additional terms will apply. Permittee Acknowledgment: I attest that the information submitted on this form and any attachments are true,complete,and accurate to the best of my knowledge. By signing this form,the permittee,its agents and employees agree to conduct the authorized activities under this permit in accordance with the attached terms and conditions and any special terms that are incorporated upon the issuance of this permit. Any violation of the term .n. onditions r f e. r tion presented may be grounds for revocation of this permit. E 7'�''q '1'067 Signature of' ttee Date Office Use Only: Accounting Date: CJ#or CC# Amount Paid: Ap r ved If Approved with Changes Additional Terms Denied I /CSI —1 1 ' sa �D� / j End`Jof eason: `J( �J I/5it7 ignature of Authorize . - Representative Date of Issu.• e TRM P&R 0-341(11/20'6) , AP :: Es :Mtorn ATT .- -T. iey City Clerk