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AGENCY <br /> • 1! WASHINGTON STATE PARKS & RECREATION COMMISSION Office Use OnlJy-:) �1 f! /V/JJ(�/ <br /> PPrrpit�O <br /> ,r,i; T Commercial Use Permit / Annual ❑ vendor <br /> Temporary Vendor Permit & Application )42) <br /> 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. <br /> 1. Busfriess 1nforination <br /> - Business Name Doing Business As(DBA) UBI or Business License Number(required) <br /> Everett Parks and Community Services 91-6001248 <br /> 2. Contact information - <br /> Contact Person/Title Field Contact(if different) <br /> Euan Robertson,Recreation Supervisor <br /> • Mailing Address City State Zip <br /> 802 E Mukilteo Blvd Everett WA 98203 <br /> E-Mail Address Business Telephone Number: Cell Phone Number: <br /> erobertson@everettwa.gov 425.257.8396 <br /> 3..Activities Depending en activity additional terms and conditions may apply . <br /> Please list activities that will be conducted. Attach additional sheet for itineraries,trips,maps,etc.(example:bicycle tours with detailed itineraries). <br /> We provide day trips for the community including walking, hiking,snowshoeing,cross country skiing and cycling. <br /> We plan to be in parks from 2-6 hours depending on the activity. <br /> How many times per year will this activity take place? Average size group? <br /> Approximately 10 times. 11 <br /> 4.,.P rkS WaslaingfoiiSta-te-Parks has ttietightto:limit useorforbid.Certain activities.frorrr taking place atspecific:parks:. .•; - ..., <br /> Please list parks where activity will take place: <br /> Wallace Falls, Cama Beach,Fort Ebey, Deception Pass,Rasar, Lake Wenatchee, Iron Horse, Larrabee <br /> • <br /> 5.:Tem Ora Vegdors'This section appliesonly-to temporaryvendorsparticipating with a special_event: • _ - <br /> p_ CY <br /> Dates of Event I Items for sale Will alcoholic beverages be sold? Yes ❑ No 0 <br /> To' <br /> If yes,additional terms will apply. <br /> r_ <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 /> r; <br /> accordance with the attached terms a . conditions and any special terms that are incorporated upon the issuance of this permit. Any violation of the em <br /> terms and conditions or fals- • -atio• presented may be grounds for revocation of this permit.dow <br /> Q <br /> ..11w-- . / .2—/9—/1 c/ <br /> a <br /> Signature of Per t - �, c f-rt i A. �� CV'!7=7 Date s <br /> ' aa. <br /> Office Use Only: Accounting 0) <br /> Date: CJ#or CC# Amount Paid: o <br /> Appr d 10 Ap. - -d with Changes n Additional Terms n Denied 1 q v r <br /> 1 <br /> Am' 1LI!LL <br /> n <br /> E <br /> n: <br /> . 4s ((q <br /> Sig ature of A, horized State�epresentative Date of Issuance ,, `_- <br /> P o-341(1 /•016) AP OVER DTOffM <br /> ATT ST: m0 <br /> A/ Mailellifillib,... :C <br /> JAMES D.ILES,Ci torney _ • Gity efl{ <br /> 1— <br />