Attendance And Participant Good Faith Estimate Page 23
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32FOOD CONCESSIONS AND PREPARATION PERMIT APPLICATION
OFFICE USE ONLY
Date _____________________________________
Non-Refundable Fees:
City License # ______________________________
License
$ 30.00
New
Renewal
Assembly Permit
$ 110.00 (required for occupancy of 50+)
Processing
$ 1.50
Central District Health Dept. Permit
(Low Risk Food Establishment Approval OR Mobile or Temporary
Total Fees Due
$________
Food Establishment Permit)
Assembly Permit (occupancy of 50 or more)
LICENSE EXPIRES ANNUALLY DECEMBER 31
st
A copy of the current Central District Health Department permit MUST be included with all applications.
Business
Name of Business
Phone
Physical Address
City
State
Zip
Mailing Address
(if different from physical address)
City
State
Zip
Owner/Manager Name
Phone
Address of Residence
City
State
Zip
Type of Business:
Restaurant
Bakery
Caterer
Mobile Unit
Bar
Cafeteria
Convenience Store
Other
If Other, please explain:_______________________________________________________________________________
Do you intend to cook food in the event area? If yes, please specify method:
Gas
Charcoal
Electric
Other (Please specify): _______________________________________
Please describe, in the space below, how food will be prepared/served. You may also provide as an attachment:
Applicant Signature
Date
Signature of Owner/Manager
Date
Updated December 23, 2011
22
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Parent category: Business