Maricopa County Environmental Services Department
Environmental Health Division Permitting Services Program
Phone: (602) 506-6824
If applicable, a follow-up inspection will automatically be scheduled at the 30 day expiration date.
Review each item and initial to acknowledge.
1. The new owner agrees to abide by the responsibilities of a permit holder as referenced in the U.S. Food and Drug Administration
2013 Food Code § 8-304.11.
2. There is an adequate supply of hot and cold water in the establishment.
3. There are sufficient plumbing fixtures in the establishment (i.e. hand sinks not leaking and able to provide hot and cold water.)
4. All plumbing fixtures are working properly (i.e. not leaking and able to provide hot and cold water.)
5. There is sufficient equipment to ensure that foods can be cooked to proper temperatures as referenced in the U.S. Food and
Drug Administration 2013 Food Code § 3-401.11.
6. There is sufficient equipment to ensure all Time/Temperature Control for Safety Food, Hot and Cold Holding can be maintained
at the temperatures as referenced in the U.S. Food and Drug Administration 2013 Food Code § 3-501.16.
7. All food is coming from safe sources.
8. All equipment is working properly (i.e. freezers, refrigerators, hoods, ovens, stoves, etc.)
9. There is no evidence of live insects or vermin activity in the establishment.
10. The following conditions do not exist and if they should happen to occur, the owner/person-in-charge shall cease operations and
contact the Department:
(a) Fire or activation of the fire suppression system
(c) Electrical or water outage
(d) Sewage backup
(e) Misuse of poisonous or toxic materials
(f) Onset of apparent foodborne illness outbreak
(g) Gross insanitary occurrence or condition
(h) Other circumstance that may endanger public health
11. The new owner agrees not to conduct any food process where a variance or HACCP plan is required in accordance with the U.S. Food and Drug Administration 2013 Food Code §§ 3-502.11, 3-502.12, 8-201.13, 8-201.14 and Subpart 8-103 which has not been issued and/or approved by the Department.
12. The new owner agrees to cease operations should the time between the ownership change and the issuance of the required
permit to operate exceeds 30 days.
13. The new owner acknowledges that the fee for the New Permit Application Inspection includes one initial inspection and one
follow-up inspection to address any items not corrected during the initial inspection. Additional fees will be assessed for any
additional follow-up inspections.
Signature of this application certifies the information provided is accurate, there are no known deficiencies at the establishment, and the
owner is in compliance with all applicable laws and regulations. In addition, the owner will not operate the establishment until approval is
given by this department. Any changes to this application must be submitted in writing to the Department for approval.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
Information entered on this form will be retained by Maricopa Environmental Services Department and is a record as defined by Arizona law.
This form will be provided without redaction in response to a public record request unless any of the information is exempt from release under Arizona law.
This field is not part of the form submission.
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