NAME OF ESTABLISHMENT *

CELL PHONE *

ALTERNATE PHONE

MAILING ADDRESS *

Address Line 1

City

State

Zip Code

TYPE OF ESTABLISHMENT *

Select One.

OWNER'S NAME *

First

Last

OWNER'S PHONE

OWNER'S ADDRESS

Address Line 1

City

State

Zip Code

MANAGER OF ESTABLISHMENT *

First

Last

MANAGER'S PHONE *

MANAGER'S ADDRESS

Address Line 1

City

State

Zip Code

TYPE OF OWNERSHIP *

INDIVIDUAL
PARTNERSHIP
CORPORATION

PERMIT AGREEMENT STATEMENT

In consideration of issuance of this permit I understand and agree to familiarize myself and comply with all laws and ordinances applicable to operation of said business and further agree to permit unrestricted access to an authorized representative of the Environmental Services – Food Safety Division for the purpose of conducting inspections necessary to verify with applicable regulations. I understand that by typing my name I am signing this legal document.

SIGNATURE *

Type your name as your signature.

TITLE

FOOD ESTABLISHMENT PERMIT APPLICATION

PERMIT AGREEMENT STATEMENT

REQUIRED SUMITTALS

CONTACT MPTX

VISIT MAIN STREET

UPCOMING CALENDAR

CITY COUNCIL MEETING

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