Food Establishment Permit Application

To register as a food establishment, please complete the form and sign the agreement below. Unless otherwise noted, all fields are required.

Food establishment inspection fee (annual): $200.00. Temporary food vendors inspection fee: $125.00. Submit fee payment at City Hall. No refunds or transfers once permit is issued to applicant.

Contact Information

Name of Business/Organization

Mailing Address

City

State

ZIP Code

Location Phone

Contact Person

Contact Phone

Email

Type of Business to Be Inspected

(check any that apply)

Mobile Food UnitMotel/HotelPeanut FestivalChurchCommunity CenterFull Serivce Restaurant, Convenience Store, or Food StoreNon-Profit Food Preparation KitchenSchool CafeteriaDaycareAdult HomeBalloon FestivalThree-Day Food Event

Establishment to Be Inspected

Name

Physical Address

City

State

ZIP Code

County

Is physical address within the city limits?

YesNo

Establishment Phone

Days of Operation

Hours of Operation

Additional Locations

For any additional locations, please upload document showing all information listed under Establishment to Be Inspected section above.

(PDF, Word, images accepted)

Non-Discrimination Statement
The following information is requested by the Federal Government in order to monitor compliance with Federal laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.

Ethnicity(optional)

Race(optional)

Verification: I swear or affirm that all information in this application is true and correct. I further certify by signature hereon, that I am authorized to execute this document. I further certify that I have read and understand Chapter 437 of the Health and Safety Code, the applicable provisions of 25 Texas Administrative Code, Chapter 229, and agree to abide by them. If you agree to all the terms and conditions stated above, sign this document electronically by typing your full name:

...and today’s date: