Fillable PERMIT APPLICATION MOBILE FOOD VENDOR 2. FOOD TYPE (City of Birmingham)

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PERMIT APPLICATION MOBILE FOOD VENDOR 2. FOOD TYPE (City of Birmingham)

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The PERMIT APPLICATION MOBILE FOOD VENDOR 2. FOOD TYPE (City of Birmingham) form is 1 page long and contains:

  • 1 signature
  • 15 check-boxes
  • 55 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Birmingham

BROWSE CITY OF BIRMINGHAM (AL) FORMS

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PRIVATE PROPERTY/OFF-STREET
MOBILE FOOD VENDOR
PERMIT APPLICATION
CITY OF BIRMINGHAM ALABAMA
Print neatly using black ink
Department of Transportation
City Hall/9
th
Floor
710 20
th
Street N
Birmingham AL 35203-2245
205.254.7783 Phone
205.254.7789 Fax
food.truck@birminghamal.gov
1. PURPOSE OF APPLICATION
(Select One) New Permit Renew a Current Permit Replace an Expired Permit
2. FOOD TYPE
Prepackaged Ice Cream Cooked Food Prepackaged Food Other (specify)
__________________________________
3. VENDING LOCATION
(Prepackaged Ice Cream vendors skip to Section 4.)
Address City State ZIP
4. VEHICLE INFORMATION
Unit Type
(Select One)
Self-Propelled Motor Vehicle (truck, van, etc.)
Trailer Pushcart Other (specify) ________________________
Year Make Model Body Style # Axles # Cylinders
Vehicle Identification Number (VIN) Overall Vehicle
Dimensions:
Width
________
X
Length
________
X
Height
______________
5. BUSINESS INFORMATION
Type of ownership: Individual Corporation Partnership LLC, LLP, Other
Legal Name of Business Operating Name / Trade Name / DBA
Business Address City State ZIP
Commissary Address City State ZIP
6. APPLICANT INFORMATION
Name (Last, First, Middle) E-mail Address Daytime Telephone
Home Address City State ZIP
7. OWNERS/PARTNERS
a.
Name (Last, First, Middle) E-mail Address Daytime Telephone
Home Address City State ZIP
b.
Name (Last, First, Middle) E-mail Address Daytime Telephone
Home Address City State ZIP
c.
Name (Last, First, Middle) E-mail Address Daytime Telephone
Home Address City State ZIP
8. BY SIGNING BELOW,
• I hereby certify that I have read this application and that all information contained herein is true. If any portion of this
information, either
intentionally or unintentionally, is false or is a misrepresentation of the material facts, the certificate
or process granted will be
void. I further certify that if I am not the owner, I have proper authorization from the owner to act as representative on his/her/
their
behalf and that I may be required to provide written documentation of such authorization to the City of Birmingham.
• I attest that neither I, nor any of my food service workers, have been convicted of any crime that involves any local, state
or federal law
or regulation during the operation of a similar business.
• I agree to hold harmless the Ci
ty and its officers and employees, and shall indemnify the City, its officers and employees for any claims
for damage to property or injury to persons which may be occasioned by any activity carried on under the terms of this permit.
• I attest that I am in compliance with the Hammon-Beason Alabama Taxpayer and Citizen Protection Act.
• Applicant for the mobile food service license requested by the aforementioned applicant hereby swears or affirms that he or s
he has
read said application and that all the statem
ents therein and the facts set forth therein are true and correct, and that the applicant is the
only person interested in the business for which said license is requested.
9. SIGN & DATE
Printed Name of Applicant
Signature of Applicant
Date Signed
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PERMIT APPLICATION MOBILE FOOD VENDOR 2. FOOD TYPE (City of Birmingham)

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Completed 6 May 2022

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