Temporary Food Permit Application

Fees(Required)

$35 per day (when paid at least seven days in advance)

$50 per day (when paid less than seven days in advance)

$140 Recurring Temporary Food Permit (for one season)

Choose the correct fee, based on the event.

Applicant Information

Organization(Required)

Provide the name of the organization that will be serving food.

Name of Applicant(Required)

First Last

Applicant Email(Required)

Applicant Phone(Required)

Event Information

Please complete the following section with the information about the event.

Event Name(Required)

Event Location(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Event Dates(Required)

Please provide all of the dates in which you will be serving food.

Set-Up Time(Required)

Provide the time you will be setting up your area for the event.

Personnel

A designated Person-in-Charge (PIC) is required to be onsite at all times. The PIC must hold a current Washington state food and beverage worker card. The PIC is responsible for reading the temporary food event requirements and for adhering to the temporary food event setup checklist.

Is the PIC the same as the applicant?(Required)

Yes

Not Sure

PIC Name(Required)

First Last

PIC Email(Required)

PIC Phone(Required)

Food Worker Card County and Expiration Date(Required)

Has the PIC held a temporary food permit before?(Required)

Yes

Food Items

Please complete the following information about the food you will be serving. Use the plus sign at the end of the first row to create additional rows. Create as many rows as needed for each item. –Food item is what will be served –Supplier/Source is where you are obtaining the food from –Onsite or Offsite Prep tells us where the food is prepared. –Cold-Holding is how you will keep cold items cold. –Hot-Holding is how you will keep items warm. –Food Service is how the food is served; i.e. buffet style, made-to-order, etc.

Food Items(Required)

Food Item

Supplier/Source

Onsite or Offsite Prep

Method of Cold-Holding

Method of Hot-Holding

Food Service

Facilities and Equipment

Please check all that apply to your specific food service.

What type of facility will be used?(Required)

Tent/Booth

Indoor

Kitchen

Other (describe below)

If you chose other above, please describe.

Where are you sourcing water?(Required)

City Water

Bottled Water

Water System Approved by WADOH

What foods will be prepared in advance of the event?(Required)

**Please note that potentially hazardous foods must be made the day of the event and NOT before.**

How will you prevent bare hand contact with the food?(Required)

Utensils

Gloves

Other (describe below)

Bare hand contact with food is strictly prohibited.

If you chose other above, please describe.

What equipment will be used to cold-hold foods?(Required)

Ice Tub

Freezer

Refrigerator

Other (describe below)

If you choce other above, please describe.

What equipment will be used to hot-hold foods?(Required)

Hot Case

Other (describe below)

If you chose other above, please describe.

What style thermometer will be used to check the temperature of potentially hazardous foods?(Required)

Digital

Dial

What restrooms are available for employees/workers?(Required)

Indoor Facility

Event Provided

Signature of Applicant(Required)

I understand that it is the responsibility of the permit holder to comply with the Lincoln County temporary food establishment regulations. Furthermore, I, the applicant, do attest that the information provided is accurate to the best of my knowledge and should any changes be made, the Lincoln County Health Department must be notified and approve any changes.

Date of Signing(Required)