GOGEBIC COMMUNIY COLLEGE Application Date    
Building Use Permit
               
                Front Desk Computer  
            Date Copies Sent  
  Date(s) to Use    
  M    T    W    TH    F    S    S     Distribution of Form  
        M. Mosconi  
                N. Kangas  
  Function/Organization     B. Panich  
          G. Switek  
  Room Number           J. Lorenson  
                   
Library  
Approximate Number to Attend:       L. Gustafson  
   
Beginning at:   Ending at:          
Organiz. (2)  
   
Person Responsible         Other:    
Organization Name         SPECIAL REQUESTS - 
Street Address                
City, State, Zip                
Business Phone                
     
Home Phone         AUDIO/VISUAL:  
Specific Activity                
Profit _____ Non Profit _____ Internal Transfer_____        
FOOD SERVICE:     MEETING ROOM:  (Attach Layout)  
_____ Yes _____ No          
_____ Organization arrange direct with Brian        
_____ GCC arrange with Brian  
        OTHER:
       
ESTIMATED FEES:        
$________ Room Rental        
$________ Maintenance
$________ Food Service
$________ Staffing Payment is due at Business Office  
$________ on or before day of event.  Deposit  
$________ required for rentals exceeding $50.  
$________ TOTAL AMOUNT DUE Custodial/repair charges will be  
assessed if facility is not left in  
Amount Received:  ______________ Date ____________ its original condition.      
Account No. to Charge          
APPROVAL:
Date________ _ Approval            
Date__________ _ Organization Signature             \usage\usepermi