Application for Temporary Food Permit

Temporary food permits are good for a single event or celebration. Temporary food permits cannot exceed more than 14 consecutive days.

The undersigned hereby makes an application to operate a temporary food establishment.

Start Date *

End Date *

Approximate Time of Completed Set-up for Inspection *

Organization or Business Name *

Address *

Address 2

City *

State *

Zip *

Phone * 111-111-1111

Person in Charge *

Contact Email *

Location Food is Served/Sold *

Location Food is Prepared *

Menu *

File

Please upload a copy of your menu.

Certified Food Protection Manager

Upload a Copy of Document and a Photo ID *

File

Name *

Position *

Expiration

Please Select Type of Permit *

Temporary Permit ($25.00)

Temporary Non-Profit Permit (No Fee - Must Enter Tax I.D.#)

Tax I.D. # (if Non-Profit)

I/We Agree Not to Display/Serve or Sell Any Items Other Than Those Listed on the Menu *