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Temporary / Seasonal Permit Application (Web Form)

2. Temporary / Seasonal Food Establishment Permit Application
   Maricopa County Environmental Services Department <br>Environmental Health Permitting Services Program <br>Phone: (602)506-6978<br>specialevents@maricopa.gov

   Maricopa County Environmental Services Department
   Environmental Health Permitting Services Program
   Phone: (602)506-6978
   specialevents@maricopa.gov

4. If you need assistance, please visit one of our locations.
   Office Locations

   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.

8. Temporary Permit Fees: For events lasting 14 days or less
   $85 more than 7 days before event / $135 less than 7 days before event

   $85 more than 7 days before event / $135 less than 7 days before event

10. Seasonal Permit Fees: For events lasting 15 to 120 days
    $180 more than 7 days before event / $230 less than 7 days before event

    $180 more than 7 days before event / $230 less than 7 days before event

12. Make checks payable to MCESD or payment can be made online once the application is accepted and reviewed.

14. Reviewing the following information is required for submitting and obtaining this permit.

16. Requirements
    Permit Requirements for Special Events (PDF)

17. Resources, Guidance and Documents
    Special Events

    Please visit our Special Events page.

19. Regulatory Bill of Rights
    Regulatory Bill of Rights (PDF)

20. Notice of Inspection
    Notice of Inspection Rights (PDF)

22. By checking the boxes below, you are acknowledging that you have received and reviewed the following:*

    1. Special Events Permit Requirements
    2. Regulatory Bill of Rights
    3. Notice of Inspection Rights

26. Event Information

28. Do you currently hold a Food Catering or Mobile Food permit with our Department?

    1. Yes
    2. No

29. Provide Permit Number

    If operating above the limited guidelines of the issued permit, a temporary/seasonal food establishment permit is required.

31. Event Start Date/Time*
    Event Start Date/Time

    Event Start Date/Time

32. Event End Date/Time*
    Event End Date/Time

    Event End Date/Time

33. Food Service Start Date and Time*
    Food Service Start Date and Time

    Food Service Start Date and Time

35. Event Name*

    Please provide complete, unabbreviated event name.

37. Event Address*

39. City*

40. State*

41. Zip Code*

43. Coordinator Name*

44. Coordinator Phone*

46. Coordinator Email*

50. Business - Name on Booth

52. Entity Type*

    1. Corporation
    2. Association
    3. Sole Proprietor (must show lawful presence)
    4. Other

54. Owner/Corporation Name*

56. Owner Address*

58. City*

59. State*

60. Zip Code*

62. Owner Phone Number*

63. Owner Contact Number During Event*

65. Owner EMail Address*

69. Commissary - Where Food is Prepared

71. Will food be prepared off site prior to the event?*

    1. Yes
    2. No

73. Commissary Business Name

75. Commissary Contact Name

76. Commissary Phone

78. List Foods Prepared at Commissary

80. Commissary Permit Number

82. Date and Time Food Prepared *
    Date and Time Food Prepared

    Date and Time Food Prepared

    If advanced preparation is taking place at commissary, please provide date/time when you will be at commissary. If all preparation is taking place at the event, please indicate what date/time you will be at event site.

83. Commissary Visits Log
    Commissary Visits Log

    Please be prepared to provide inspector with commissary visits log upon request during inspection at event.

87. Food/Beverage Booth Information

89. Will you be operating more than one food / beverage booth?*

    1. Yes
    2. No

90. Enter Number of Booths*

92. Booth and Type of Food / Beverage

94. Booth Name*

95. Menu*

97. Booth Name

98. Menu

100. Booth Name

101. Menu

103. Booth Name

104. Menu

106. Booth Name

107. Menu

109. Booth Name

110. Menu

112. Booth Name

113. Menu

115. Booth Name

116. Menu

118. Booth Name

119. Menu

121. Booth Name

122. Menu

124. 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.

     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.

126. 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. By checking the check box and typing your name you have digitally signed this application.

128. I agree the application is true and correct.

     1. I agree

130. 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.

     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.

132. Signature

133. Date
     Date

135. Once the application has been submitted, you should receive a confirmation email from the Special Events Program.
     Then once our staff has received your application you will receive a follow-up email to provide details on permit fees.

     Then once our staff has received your application you will receive a follow-up email to provide details on permit fees.

Leave This Blank:


137. 1. Receive an email copy of this form.
138. Email address

     This field is not part of the form submission.

139. Submit Submit and Print

* indicates a required field