GRANT COUNTY HEALTH DISTRICT
PO BOX 37, EPHRATA WA 98823
(509)754-6060
PERMIT APPLICATION FOR A FOOD SERVICE
PLEASE RETURN THE COMPLETED APPLICATION ALONG WITH THE CORRECT FEE.
NAME OF ESTABLISHMENT_______________________________________________________________________________________
TYPE OF FOOD ESTABLISHMENT__________________________________________________________________________________
STREET ADDRESS OF OPERATION_______________________________________CITY,STATE,ZIP__________________________
MAILING ADDRESS___________________________________________________CITY,STATE,ZIP_____________________________
BILLING ADDRESS____________________________________________________CITY, STATE, ZIP____________________________
NAME OF LEGAL OWNERS________________________________________DATE BUSINESS PURCHASED_____________________
FORMER NAME OF BUSINESS_____________________________________________________________________________________
NAME OF PRESIDENT/MANAGER__________________________________________________________________________________
BUSINESS PHONE #_______________________________AFTER HOURS/EMERGENCY PHONE #______________________________
DAYS OF OPERATION______________________________________________HOURS OF OPERATION__________________________
NAME OF WATER SYSTEM__________________________________________STATE ID #_____________________________________
METHOD OF SEWAGE DISPOSAL___________________________________________________________________________________
I HAVE ENCLOSED $_____________FOR A FOOD SERVICE PERMIT. Please refer to the fee schedule printed on the
back of this form to determine the annual permit fee.
IN ACCORDANCE WITH THE PROVISIONS OF ALL APPLICABLE HEALTH ORDINANCES, RULES AND REGULATIONS, I
HEREBY APPLY FOR A PERMIT TO OPERATE A FOOD SERVICE ESTABLISHMENT.
I UNDERSTAND THAT:
1. PERMITS ARE RENEWABLE ANNUALLY AND EXPIRE DECEMBER 31. PERMITS SHALL BE RENEWED BY
JANUARY 1. DELINQUENT APPLICATIONS AND PERMIT FEES MAY RESULT IN CLOSURE. SEASONAL OPERATIONS
SHALL OBTAIN THE PERMIT PRIOR TO THE OPENING DATE.
2. PERMITS ARE NON-TRANSFERABLE, AND ARE VALID ONLY FOR THE CURRENT OPERATOR AND THE
ESTABLISHMENT LISTED ON THIS APPLICATION. CHANGES IN THE OPERATION OR LOCATION OF THE FOOD
SERVICE ESTABLISHMENT REQUIRE PRIOR APPROVAL BY THE HEALTH DISTRICT AND MAY REQUIRE ADDITIONAL
PERMITS.
3. $30.00 OF EACH REQUESTED REFUND OF A PERMIT FEE WILL BE RETAINED BY THE HEALTH DISTRICT FOR
ADMINISTRATIVE EXPENSES.
4. NO NEW PERMIT WILL BE ISSUED TO PERSONS OR BUSINESSES HAVING AN OUTSTANDING DEBT TO THE
HEALTH DISTRICT.
APPLICANTS
SIGNATURE______________________________________________________DATE____________________
DO NOT WRITE BELOW THIS LINE
*********************************************************************************************************
Approval date_________________By__________Receipt No._________________By___________Date___________________
Disapproval date______________By__________Amount Received______________Date Permit Mailed___________________
INSTRUCTIONS: Please check the blanks next to the category or categories which best describes your
food service operation. You may also use these blanks to assist in tabulating your annual fee.
I. PRE-OPENING INSPECTION Required for all new establishments, new
owners, or new locations.
$130.00___________
PLAN REVIEW (required for all new establishments not licensed within Grant
County in the last two years, or undergoing extensive remodeling)
II. FOOD SERVICE LICENSE
Complex
Simple
With Lounge Area
$130.00___________
$370.00____________
$250.00____________
$ 75.00____________
(additional fee)
III. UNIQUE FOOD SERVICE LICENSES
ESPRESSO STAND - no or limited food service*
WINERY- no or limited food service*
TAVERN with no or limited food service*
BED AND BREAKFAST
MEAT/FISH MARKET only
BAKERY only
CATERING only
FRUIT and VEGETABLE Stand with limited food service*
LIMITED FOOD SERVICE (Non-Hazardous)
SCHOOL KITCHEN
SCHOOL KITCHEN - Satellite
VENDING MACHINE – potentially hazardous foods, per machine
$120.00____________
$120.00____________
$120.00____________
$165.00____________
$115.00____________
$115.00____________
$110.00____________
$ 70.00____________
$ 45.00____________
$250.00____________
$125.00____________
$ 35.00____________
IV. GROCERY with prepackaged potentially hazardous food cold holding
With Food Service
(additional fee)
With Bakery
(additional fee)
With Meat Cutting
(additional fee)
With Produce
(additional fee)
With Limited Food Service
(additional fee)
With Bulk Food
(additional fee)
$145.00____________
$165.00____________
$ 80.00____________
$ 80.00____________
$ 80.00____________
$ 35.00____________
$ 35.00____________
V.
Late Fee or Operating without a valid license is double normal license fee.
Late Fee will be assessed when a renewal is delinquent for more than thirty days or a
new owner of an existing establishment (licensed during current year in Grant County) is
delinquent for more than thirty days in applying for a new permit.
*Complex -
*Simple *Limited -
A) Any hot holding of potentially hazardous foods (PHF), OR
B) Serves PHF which requires two or more of the following steps:
1. cooking raw meat and other PHF;
2. cooling previously cooked PHF;
3. reheating PHF which were previously cooked in the food service
establishment.
Cooks or serves Potentially Hazardous Foods per individual order.
Serves only Non-Potentially Hazardous Foods, -ORFoods which require minimal preparation or handling, such as popcorn, dispensing
drinks, soft ice cream, sno cones, reheating fully cooked commercially prepackaged
food (no hot holding PHF), etc.
If you have any questions, please call our office before sending in the fee.
FOODLIC.WPS 11/01/05
GRANT COUNTY HEALTH DISTRICT
P.O. BOX 37
EPHRATA, WA 98823
PHONE 754-6060
PRELIMINARY CHECKLIST TO OBTAIN A FOOD SERVICE LICENSE
WAC 246-215 REGULATIONS OF MAY 1992
PRIOR TO THE ISSUANCE OF A LICENSE TO DISPENSE FOOD TO THE PUBLIC, THE APPLICANT MUST PROVIDE
EVIDENCE SATISFACTORY TO THE HEALTH AUTHORITY THAT THE FOLLOWING ITEMS HAVE BEEN
ADEQUATELY ADDRESSED:
[ ]
MAKE APPLICATION FOR A FOOD SERVICE LICENSE WITH THE GRANT COUNTY HEALTH DISTRICT
(G.C.H.D.)
[ ]
PAY CURRENT FEE, PLEASE SEE THE BACK OF YOUR APPLICATION FOR FEES.
[ ]
IF YOU ARE A NEW BUSINESS OWNER OR ARE EXTENSIVELY REMODELING AN EXISTING BUSINESS
(ANY REMODELING REQUIRING A BUILDING PERMIT), YOU MUST SUPPLY G.C.H.D. WITH DETAILED
PLANS OF THE NEW BUILDING OR REMODEL.
[ ] TYPE OF FLOORING
[ ] TYPE OF WALLS
[ ] TYPE OF COUNTER TOPS
(ALL MUST BE OF AN EASILY CLEANABLE MATERIAL)
[ ] LABEL ALL SINKS ON PLANS AND INDICATE WHAT THEY WILL BE USED FOR.
[ ]
RECEIVE APPROVAL OF PLANS FROM G.C.H.D.
[ ]
CALL G.C.H.D. FOR A PRE-OPENING INSPECTION (509) 754-6060 or 766-7960
[ ] BE READY FOR OPERATION BEFORE CALLING FOR AN INSPECTION.
[ ] IS REQUIRED FOR ALL NEW OWNERS AND REMODELED ESTABLISHMENTS.
[ ] REFRIDGERATION AT PROPER TEMPERATURES [ ] WATER IS HOT.
[ ] THERMOMETERS [ ] SOAP AND PAPER TOWELS ARE PROPERLY INSTALLED, ETC.
ALL FOOD ESTABLISHMENTS MUST HAVE THE FOLLOWING:
[ ] WATER FROM AN APPROVED SOURCE, SUCH AS CITY WATER OR AN APPROVED COMMUNITY WELL.
[ ] SHOW RESULTS OF A COLIFORM BACTERIA FOR COMMUNITY WELL, TEST DATED WITHIN THE LAST
THIRTY DAYS OF OPENING
[ ] HAVE AN APPROVED SEWAGE DISPOSAL SYSTEM.
[ ] ADEQUATE STORAGE AND REFRIGERATION FACILITIES FOR FOOD SUPPLIES.
[ ] HAND WASHING SINKS
[ ] ADEQUATE IN NUMBER
[ ] PROPERLY LOCATED IN FOOD PREERATION AND TOILET AREAS
[ ] SINKS MUST HAVE WARM WATER, SOAP AND PAPER TOWELS.
[ ] ADEQUATE DISHWASHING AND POT AND PAN WASHING FACILITIES
[ ] TWO (2) COMPARTMENT SINK (TO BE USED FOR WASHING PANS, ETC. THAT WILL NOT FIT INTO THE
DISHWASHER) AND AN APPROVED (COMMERCIAL) DISHWASHING MACHINE WITH PRE-RINSE.
OR
[ ] THREE (3) COMPARTMENT SINK TO WASH, RINSE AND SANITIZE DISHES, ETC.
[ ] SINKS MUST HAVE DRAIN BOARDS BEFORE AND AFTER FOR SOILED DISHES AND TO AIR DRY
CLEAN DISHES.
[ ] SINKS MUST HAVE HOT AND COLD RUNNING WATER.
[ ] TAVERNS AND COCKTAIL BARS:
[ ] MUST HAVE A DISHWASHER OR A THREE (3) COMPARTMENT SINK WITH DRAIN BOARDS BEFORE
AND AFTER.
[ ] MUST HAVE A MOP SINK FOR LIQUID WASTE. (MOP SINK AND HAND SINK CAN BE THE SAME SINK
UNLESS USAGE AS A MOP SINK WILL INTERFERE WITH HAND WASHING).
[ ] FOOD PROCESSING AND MEAT MARKETS: THREE (3) COMPARTMENT SINK WITH DRAIN BOARDS
BEFORE AND AFTER.
[ ] PRODUCE MARKETS: PRODUCE WASH SINK WITH. INDIRECT PLUMBING.
[ ] FOOD SERVICE ESTABLISHMENT OWNERS SHALL PROHIBIT USE OF FOOD PREPARATION SINKS FOR:
[ ] HAND WASHING
[ ] UTENSIL WASHING
[ ] ANY OTHER ACTIVITIES THAT MAY CONTAMINATE FOODS.
[ ] WATER SUPPLY, PLUMBING AND SEWAGE DISPOSAL TO MEET LOCAL CODES.
[ ] ADEQUATE TOILET FACILITIES FOR WORKERS AND CUSTOMERS (FACILITIES FOR CUSTOMERS
NECESSARY FOR NEW/REMODEL BUSINESSES).
[ ] GARBAGE CONTAINER CLEANING FACILITIES.
[ ] ADEQUATE SIZE GARBAGE STORAGE AREA, EITHER CONCRETE OR RAISED RACK.
[ ] FLOORS, WALLS, CEILINGS AND COUNTERS OF EASILY CLEANABLE MATERIALS.
[ ] EMPLOYEE DRESSING ROOMS AND CLOTHING LOCKERS OR EQUIVALENT.
[
[
[
[
]
]
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DIPPER WELL WITH RUNNING WATER FOR HARD ICE CREAM SERVICE.
ADEQUATE VENTILATION HOODS AND DEVICES OVER COOKING EQUIPMENT.
ADEQUATE LIGHTING.
PREMISES DESIGNED TO EXCLUDE AND CONTROL VERMIN.
[ ] SERVICE SINKS WITH ANTI-SIPHON DEVICE USED FOR MOPPING AND OTHER SIMILAR CLEANING
OPERATIONS.
[ ] ALL FOOD SERVICE WORKERS MUST HAVE FOOD WORKER CARDS.
IN ADDITION TO NEW BUILDINGS AND REMODELS, NEW OWNERS MUST BRING EXISTING BUSINESS UP TO
CODE.
MOBILE UNITS; IN ADDITION TO COMPLYING WITH THE ABOVE REGULATIONS:
[ ] HOLDING TANKS FOR POTABLE (DRINKING WATER) AND NON-POTABLE (WASTE) WATER OR BE SET UP
PERMANENTLY WHERE AN APPROVED WATER SOURCE AND SEWAGE DISPOSAL ARE AVAILABLE.
[ ] IF REST ROOMS (with proper disposal or holding tank) IS NOT AVAILABLE IN THE UNIT, THE UNIT MUST BE
LOCATED IN AN AREA WHERE A RESTROOM IS ACCESSIBLE FOR WORKERS. WHEN USING FACILITIES
AT ANOTHER BUSINESS, WRITTEN PERMISSION SHOWING THE HOURS OF THE DAY THE FACILITIES
WILL BE AVAILABLE TO THE MOBILE UNIT MUST BE PROVIDED FOR OUR FILES.
[ ] MOBILE UNITS MUST HAVE BUSINESS NAME PRINTED ON OUTSIDE IN LETTERS OF TWO (2) INCHES OR
MORE.
[ ] SUPPLY G.C.H.D. WITH THE FOLLOWING:
[ ] MENU (FOOD PREPARATION STEPS)
[ ] PROPOSED ITINERARY OR SITES TO BE SERVED
[ ] SITE TO BE USED FOR SEWAGE DISPOSAL
AS IN ALL FOOD ESTABLISHMENTS
[ ] FOOD MUST COME FROM AN APPROED SOURCE, SUCH AS GROCERY STORES, USDA LICENSED
BUTCHER OR A LICENSED FOOD SUPPLIER
[ ] ALL FOOD WORKERS MUST HAVE FOOD HANDLER CARDS.
ESPRESSO BARS:
[ ] NAME ON CART
[ ] HAND SINK WITH RUNNING WATER (HOT AND COLD TEMPERED) FROM AN APPROVED SOURCE. THE
HAND SINK MUST BE ON, OR PERMANENTLY ATTACHED TO THE CART. THE ONLY EXCEPTION IS IF
ESPRESSO BAR IS STATIONARY IN A BUILDING WITH A HAND SINK IN CLOSE PROXIMITY OF THE BAR.
[ ] RESTROOM AVAILABLE WITHIN 200 FEET OF CART
[ ] MUST HAVE A LETTER FROM BUSINESS GIVING PERMISSION TO USE THE REST ROOMS AND THE
HOURS THEY WILL BE AVAILABLE TO YOU.
[ ] A 3 COMPARTMENT SINK MUST BE ON THE CART OR UTENSILS MUST BE TAKEN TO ANOTHER
LOCATION WHERE THERE IS ACCESSIBILITY TO A 3 COMPARTMENT SINK (FOR WASHING, RINSING, AND
SANITIZING UTENSILS, ETC). THIS CAN BE YOUR OWN COMMISSARY OR ANOTHER LICENSED
FACILITY.
[ ] IF IT IS AT ANOTHER BUSINESS, YOU MUST HAVE THEIR PERMISSION IN WRITING STATING THE OURS
THAT THEIR FACILITY WILL BE AVAILABLE TO YOU.
[ ] IF CART IS LICENSED FOR A PARTICULAR SPOT, YOU CANNOT MOVE WITHOUT NOTIFYING G.C.H.D.
IF MORE THAN ONE ESPRESSO CART IS OWNED, EACH CART MUST HAVE A SEPARATE LICENSE.
[ ] STATIONARY BUILDINGS – WITHOUT WATER - CAN USE WATER BROUGHT IN FROM AN APPROVED
SOURCE.
[ ] STATIONARY BUILDINGS – WITH WATER – MUST HAVE THE WATER IN THE BUILDING APPROVED AS A
PUBLIC WATER SOURCE.
F:Food/Policy/Chcklist.doc 7/20/00