Fillable New-renewal-food-establishment-application City of Stafford

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New-renewal-food-establishment-application City of Stafford

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U.S.A. forms for City of Stafford, TX

BROWSE CITY OF STAFFORD, TX (TX) FORMS

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City of Stafford
2610 South Main Stafford, Texas 77477
(281) 261 3941 permits@staffordtx.gov Fax: (281) 261 3939
Food Establishment & Renewal Permit Application
Establishment Name: Hours of Operation:
Establishment situs address:
Do you wish for renewal to be sent to location other than situs address?
YES NO Email: Mailing address:
Do you wish for a copy of the permit to be sent to location other than situs address?
YES NO Email: Mailing address: Fax:
Mailing Address: (if different than above)
Establishment Phone #:
Establishment Fax #:
Establishment Email:
Director / General Manager/ Person in Charge
Cell#:
Email:
Corporate Contact Name: (if applicable)
Corporate Address:
Corporate Contact Phone # :
Fax:
Corporate Email:
Property Owner:
Property Owner Address:
Property Owner Phone # :
Property Owner Email:
Emergency Contact Name Title Phone#
Certified Food Protection Manager(s) (for additional
certified personnel use additional sheet of paper)
License #
Issued By:
For Day Care Facitilies: (only)
In-house food Preparation
Outside Catering
(If outside catering, Caterer must register as a caterer)
Age Range of Children
Name, Address, & Phone # of Caterer
Food Establishment Annual Fee determined by
Sq. Footage (entire facility minus area that food or
drink is not allowed in i.e. dance floor, gym, etc.)
Total Square footage:
Pre Opening Inspection Plus
$150.00
Less than 5000 Sq. ft.
$300.00
> 5000 sq. ft. and < 10,000 sq.ft.
$500.00
Accepted by: Approved by:
> 10,000 sq. ft.
$700.00
Receipt Number :
TOTAL DUE
Signature of Applicant:
Printed Name:
Date:
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New-renewal-food-establishment-application City of Stafford

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Completed 1 November 2019

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