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City of Bonney Lake - Executive

9002 Main Street East, Suite 200 Bonney Lake, WA 98391



Location: 18424 89th Street East, Bonney Lake

Instructions: Provide all requested information. Sign, date, and submit the form. Send payment to:

Mail: City of Bonney Lake, Attn: Community Garden, 9002 Main St E, Ste 200, Bonney Lake, WA 98391

In person: 9002 Main St E, Suite 200, Bonney Lake, WA 98391

City of Bonney Lake Resident?

Full Name

Additional Applicant Name

Full Address

Single Plot Request

Double Plot Request

*Per BLMC 3.90.050 a 50% discount is available for senior/disabled persons who qualify for a water rate discount per BLMC 13.04.100(A) and for adults with a current valid Washington State Electronic Benefits (EBT) card.

The City may share applicant information with Harvest Pierce County (part of the Pierce Conservation District) for organizing and development.

The undersigned hereby applies to the City of Bonney Lake for use of the above community garden plot and certifies the information is correct and furthermore agrees to abide by all ordinances, policies, and rules and regulations which may apply.

The applicant hereby agrees to indemnify and hold harmless the City of Bonney Lake and its officers, agents, officials, employees, and volunteers, from and against any and all claims, demands, suits, action, payments and judgments as a result of injury or death of any person or property damage to any property sustained by applicant or any other persons which arise from or in any manner grow out of any act or omission on or about said facility by applicant, its agent, guest, or employees, in the execution of this Garden Plot Request Form including any and all expenses, legal or otherwise incurred by the City or its representatives in the defense of any suit or claim.

The applicant agrees to follow guidelines established by the City of Bonney Lake.

Forms submitted to the City may be subject to public disclosure under the Washington State Public Records Act (RCW 42.56).

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Date Received: __________________  By:____________________

Amount Paid: _______________________ on ____________________

Approved By: _________________________________ on ________________

Plot #: _______________________