Fillable Temporary Food Service Permit Application (City of Plano)

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Temporary Food Service Permit Application (City of Plano)

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Temporary Food Service Permit Application
Environmental Health & Sustainability
1520 K Avenue, Suite 210, Plano, TX 75074
Email: envhealth@plano.gov
Office: 972-941-7143 Fax: 972-941-7142
http://www.plano.gov/201/Environmental-Health
A. PERMIT TYPES / FEES
PERMIT FEES ARE NON-REFUNDABLE
Food Vendor Not Permitted with the City of Plano (First Booth)
$95.00
Food Vendor Not permitted with the City of Plano (Each Additional Booth)
$25.00
Food Vendor Permitted with the City of Plano (Per Booth)
$20.00
Not-for-Profit – Verification Required. (Application Processing Fee Only)
$20.00
A Late Fee is assessed if your application is submitted less than five (5) working days prior to the event,
or 14 working days prior to the event if five (5) or more booths are permitted for the event.
$50.00
Applications WILL NOT be accepted after 4:00 p.m. on Thursday immediately preceding event.
B.
APPLICANT INFORMATION
Business Name:
Contact Person:
Mailing Address:
Date Received
Env. Health Approval
Fee Amount: ___________________
Paid: __________________________
Cash Check Money Order
Visa Master Card
Receipt Number: ______________
Ma
il
Pick Up
City:
State:
Zip:
Out of Town Vendor: Yes No - If yes, submit copy of health permit and
most recent inspection report with application.
Email:
Phone:
What time will booth be set up and ready for inspection? ______ AM PM
Food Prep Begins ______ AM PM
Name of food handler in charge at booth: ______________________________
Does the person in charge at the booth possess a food handler card or a food
manager certification? Yes No
Are you a Not-for-Profit 501(C)(3) Tax Exempt Organization?
Yes
No
SUBMIT COPY OF TAX EXEMPT CERTIFICATE IF APPLICABLE
C. EVENT/ORGANIZER INFORMATION
Event Name:
Event Address:
Event Start Date:
Event End Date:
Event Start Time:
AM
PM
Event End Time:
AM
PM
Expected Attendance at Event:
Event Held
Indoors
Outdoors
Name of Event Organizer:
Cell Phone:
Event Organizer Email Address:
OUTDOOR EVENTS: The food preparation and serving area must have a fire resistant overhead covering that protects the
interior from the weather. If a 200 square foot tent with sides, or a 400 square foot tent without sides is used, then a tent permit
must be obtained from Building Inspections Department at 972-941-7140.
D. FOOD INFORMATION
Please list specific menu items, including drinks to be served. Foods prepared at home are not approved and shall not be
offered for consumption.
List on-site cooking equipment:
List on-site hot and/or cold holding equipment:
Name and address of food supplier (i.e., grocery store)
Will food preparation or cooking take place prior to the event? Yes No
If yes, provide name and address of restaurant:
E. SITE INFORMATION
3-Compartment Sink for Warewashing? Yes No Sanitizer Test Strips? Yes No
Toilet and Handwashing Facilities Available? Yes No
Name and Contact Information of Person Responsible for Trash and Liquid Waste Disposal:
F. PERSONNEL / EMPLOYEE INFORMATION
Person(s) preparing food/drink. List ALL employees/volunteers for ALL shifts (use additional page if needed)
Person(s) serving food/drink. List ALL employees/volunteers for ALL shifts (use additional page if needed).
Person(s) cleaning up. List ALL employees/volunteers for ALL shifts (use additional page if needed)
G. ADDITIONAL CONTACTS
Special Events Permit (Parks Department)
Contact 972-941-7288
Fire Department: Contact 972-941-5261
(for Fire Department requirements)
Building Inspections: Contact 972-941-5261 (for temporary sale permit and tent permit)
REQUIRED SIGNATURE: I /WE agree that the issuance of this permit is contingent upon satisfactory compliance with the City
of Plano Food Ordinance. Any non-compliance observed during inspection may result in the revocation of my temporary food
permit, and I must immediately cease operation.
Applicant’s Signature:
Date:
DID YOU REMEMBER TO:
• COMPLETELY FILL OUT APPLICATION
• SIGN APPLICATION
• ATTACH COPY OF PERMIT AND MOST RECENT INSPECTION REPORT
• ATTACH COPY OF TAX EXEMPT CERTIFICATE IF APPLICABLE
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Temporary Food Service Permit Application (City of Plano)

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Completed 14 July 2020

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