Fillable TEMPORARY PERMIT APPLICATION (Maricopa County Telecommunications)

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TEMPORARY PERMIT APPLICATION (Maricopa County Telecommunications)

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Maricopa County Environmental Services Department
Environmental Health Permitting Services Program
Phone: (602)506-6824
SpecialEvents@mail.maricopa.gov
TEMPORARY PERMIT APPLICATION
(For events lasting 14 days or less)
Follow all instructions below to ensure a complete application and to avoid delays in
the application review process.
Reviewing the following information is required before submitting and obtaining a permit to operate at a Special Event:
Notice of Inspection Rights
Regulatory Bill of Rights
Make checks payable to MCESD. We also accept Visa, Mastercard, American Express and Discover.
If submitting application electronically, payment can be made via online once the application is accepted and reviewed.
Fees are non-refundable.
Permit Submittal Category Fee Calculation/Booth Total Fee/Booth
Application Submitted > 7 Days from Event $85.00 $85.00
Application Submitted < 7 Days from Event $85.00 + $50.00 (late fee) $135.00
Special Events Permit Fees
http://www.maricopa.gov/DocumentCenter/View/6675
http://www.maricopa.gov/documentcenter/view/6307
Pg.1
By checking the boxes below, you are acknowledging receipt of the Regulatory Bill of Rights and Notice of Inspection Rights:
Permit Requirements at Special Events
http://www.maricopa.gov/DocumentCenter/View/6310
For office locations please visit: http://www.maricopa.gov/2505/Locations-Hours.
If you are visiting one of our regional offices, we recommend that you call the office first to ensure the office is open
so as to better serve your needs.
Maricopa County Environmental Services Department
Environmental Health Permitting Services Program
Phone: (602)506-6824
SpecialEvents@mail.maricopa.gov
Notice
A.R.S § 11-1604. Prohibited acts by county and employees; enforcement; notice
• A county shall not base a licensing decision in whole or in part on a licensing requirement or condition that is not
specifically authorized by statute, rule, ordinance or delegation agreement. A general grant of authority does not
constitute a basis for imposing a licensing requirement or condition unless the authority specifically authorizes the
requirement or condition.
• Unless specifically authorized, a county shall avoid duplication of other laws that do not enhance regulatory clarity and
shall avoid dual permitting to the maximum extent practicable.
• This section does not prohibit county flexibility to issue licenses or adopt ordinances or codes.
• A county shall not request or initiate discussions with a person about waiving that person's rights.
• THIS SECTION MAY BE ENFORCED IN A PRIVATE CIVIL ACTION AND RELIEF MAY BE AWARDED AGAINST A COUNTY. THE
COURT MAY AWARD REASONABLE ATTORNEY FEES, DAMAGES AND ALL FEES ASSOCIATED WITH THE LICENSE
APPLICATION TO A PARTY THAT PREVAILS IN AN ACTION AGAINST A COUNTY FOR A VIOLATION OF THIS SECTION.
• A COUNTY EMPLOYEE MAY NOT INTENTIONALLY OR KNOWINGLY VIOLATE THIS SECTION. A VIOLATION OF THIS SECTION
IS CAUSE FOR DISCIPLINARY ACTION OR DISMISSAL PURSUANT TO THE COUNTY'S ADOPTED PERSONNEL POLICY.
• THIS SECTION DOES NOT ABROGATE THE IMMUNITY PROVIDED BY SECTION 12-820.01 OR 12-820.02.
Pg.2
Maricopa County Environmental Services Department
Environmental Health Permitting Services Program
Phone: (602)506-6824
SpecialEvents@mail.maricopa.gov
Event Address:
Event Name:
EVENT INFORMATION
City:
Coordinator Name: Coordinator Phone:
Please provide all requested Information below (Please print)
Do you currently hold a Food Catering or Mobile Food permit with our
Department?
Event Start Date: Event End Date:
Coordinator Email:
Yes
Permit#:
No
Business Fax:Business Phone:
City: State: Zip:
Business Address:
Business Name:
BUSINESS INFORMATION (Name on Booth)
BUSINESS OWNERSHIP INFORMATION (Responsible Party)
Entity Type:
Sole proprietor (Must Show Lawful Presence) Corporation Association Other
Owner/Corporation Name:
Owner Address:
City: State: Zip:
Owner Phone: Owner Fax: Email:
Will food be prepared or stored off site prior to the event?
COMMISSARY/FOOD PREPARATION INFORMATION (no food may be stored/prepared in an unpermitted facility)
Pg. 3
Commissary Business Name:
Commissary Contact Name: Contact Phone:
List Foods Prepared at Commissary:
Date food Prepared: Time food prepared:
Commissary Permit #
Yes (if yes, provide commissary info; all fields required) No (all food stored/prepared at event; date/time fields are required)
Will you be operating more than one food/beverage booth?
Yes No
Booth Booth Name Menu
1
2
3
4
5
Food/Beverage Booth Information (Attach a separate sheet if needed)
# of Booths
I agree the application is true and correct.
Signature:
Date:
Pg. 4
Delivery of Inspection Reports
Pursuant to A.R.S. § 41-1009, the Department may enter your establishment to conduct inspections. You have the right to receive a copy of the
Department's inspection report at the time of the inspection, within thirty (30) days after the inspection, or as otherwise provided by federal law. I
agree that the Department may send me a copy of its inspection report by e-mail or by facsimile transmission to the e-mail or fax number provided
under the Business Ownership Information provided above. It is the responsibility of the permit holder to update the Department if there is a change
in contact information.
I hereby certify that the above information is correct, agree to comply with the Maricopa County Environmental Health Code, agree to
allow the regulatory authority access to the establishment as specified under § 8-402.11 and to the records specified under §§
3-203.12 and 5-205.13 and Subparagraph 8-201.14(D)(6), and I fully understand that any deviation from the above without prior
permission from the Maricopa County Environmental Services Department may nullify final approval.
Disclaimer
Information entered on this form will be retained by Maricopa Environmental Services Department and is a record as defined by Arizona law.
This form will be provided without redaction in response to a public record request unless any of the information is exempt from release under
Arizona law.
By checking the check box and typing your name you have digitally signed this application.
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TEMPORARY PERMIT APPLICATION (Maricopa County Telecommunications)

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Completed 6 August 2020

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