Mobile Food Preparation Vehicle Permit ApplicationCITY OF PORT ORCHARD
Permit Center
uui Office located at 720 Prospect Street
Mailing address: 216 Prospect Street
" I Port Orchard, WA 98366
(360) 874-5533 • permitcenter@cityofportorchard.us
MOBILE FOOD PREPARATION VEHICLE PERMIT APPLICATION
Incomplete submittal will not be accepted.
1. CONTACT INFORMATION.
Applicant Name (Responsible Party):
Company Name:
Applicant's Relationship to the Company:
Mailing Address:
Mailing City, State, Zip Code:
Phone:
Email:
Applicant Signature: The applicant is the primary contact for all related questions and correspondence. The
Permit Center will email or call the applicant with requests and/or information about the application. The
applicant is responsible for communicating information to all parties involved with the application. It is the
responsibility of the applicant to ensure their contact information is accurate and that their email account
accepts email from the Permit Center.
I declare that I am the responsible party for the location and operation of the food truck.
I affirm that all answers, statements, and information submitted with this application are correct and accurate to
the best of my knowledge.
I understand that by applying for this permit, I am consenting to the inspection of this property and to the entry
onto the property by inspectors of the authority having jurisdiction for the purpose of performing the necessary
inspections during normal business hours for the duration of this permit.
X Date:
Applicant Signature
2. BUSINESS INFORMATION.
Vendor Name (DBA; name on truck):
Site Location(s):
Days and Hours of Operation:
UBI #:
L&I # (VEN):
License Plate #:
Do you have a City Business License? ❑ Yes ❑ No*
*A Mobile Vendor cannot operate within the City limits without Port Orchard license endorsement.
Apply online at: https://dor.wa.gov/manage-business/city-license-endorsements
Will the truck will be located on private property? ❑ Yes ❑ No
Will the truck be located in the City right-of-way? ❑ Yes ❑ No
Will all food preparation and packaging be done at a commissary or another permitted commercial
establishment? ❑ No ❑ Yes
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3. MOBILE FOOD PREPARATION VEHICLES.
A permit is required for mobile food preparation vehicles equipped with appliances that produce smoke or
grease -laden vapors or utilize LP -gas sstems or CNG gass stems.
Proposed Operation (check all that apply):
❑ Compressed gas: storage, use or handling.
❑ LP -gas use.
❑ Type 1 Hood.
❑ Hood suppression system
4. SUBMITTALS. Electronic submittals are preferred. Contact the Permit Center.for formatting and resolution
requirements. If paper copies are submitted, include one (1) copy of each item submitted.
Check the box for each item included with this application:
❑ Completed Mobile Food Preparation Vehicle Permit Application (this form) required
❑ Permit documentation from KPHD (Kitsap Public Health District) for food truck. required
❑ Permit documentation from KPHD for Commissary or other commercial establishment preparing and
packaging food. required
❑ A copy of the inspection, test and/or cleaning reports for your commercial range hood, fire suppression
system and extinguishers, completed by your Inspection, Maintenance and Testing Contractor. required
❑ A copy of the active operational permit from Kitsap County or approved neighboring jurisdiction. required
❑ A written statement, signed and dated by the property owner, granting permission for the mobile food
preparation vehicle tooperate on the property. required
❑ A City Right -of -Way permit. required
Other documentation may be required in addition to what is listed above.
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