Temporary Food Permit Application

Temporary Food Service Establishment Application/Permit
Person in Charge *
Establishment Name *
Address for Person in Charge *

Mailing Address

Street Address Line 2

City State

Zip
Email Address *
example@example.com
Phone Number *
Event Name *
Event Location Street Address/Nearest Intersection *
Event Dates *
Desired Date and Time For Inspection *
Menu Items *
Will any food be prepared before the event? *

Yes No
Do you have a commissary? *

Yes No
If yes to having a commissary, please attach commissary agreement, permit and most recent inspection.

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Cancel of
Food CANNOT be served or sold until permit has been granted. Permit will not be granted until after inspection is completed.
By singing this application you agree to the Platte County Health Department Food Protection Ordinance and Missouri Food Code. The Platte County Food Protection Ordinance can be found at plattecountyhealthdept.com. *

Clear
Date *

Month Day Year
Date
If application is submitted less than 14 days prior to the event, additional fees will apply.

Fee *

Permit Fee

$ 25.00

Total

$ 0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Temporary Food Service Establishment Application/Permit

Food CANNOT be served or sold until permit has been granted. Permit will not be granted until after inspection is completed.

If application is submitted less than 14 days prior to the event, additional fees will apply.