Temporary Health Permit

In order to complete the application process you must pay the permit fee either with a credit card by phone at 817-392-7255 or in person at the Fort Worth Consumer Health Division, 818 Missouri Ave.

Booth Number:

Applicant's Name:

Description of proposed event or activity:

Date(s) of event or activity:

Time of Operation: start finish

Location of event or activity:
Street Address: MAPSCO:

Name of Organization:

Responsible Person(s) Information:

Name:

Address:
City:

State:

Zip Code:

Phone:

Do you operate food establishments at other locations?

If yes, provide names and addresses:

Please list the foods to be served and the places that the foods will be prepared and stored:
**NOTE: ONLY LISTED FOODS AND BEVERAGES ARE AUTHORIZED. TEMPORARY FOOD/BEVERAGE STANDS MUST COMPLY WITH ALL FORT WORTH REQUIREMENTS INCLUDING APPLICABLE FOODHANDLERS CERTIFICATION, REQUIRED SINKS, FOOD TEMPERATURES, STAND CONSTRUCTION, ETC. CALL 817-392-7255 FOR INFORMATION.

Food items to be served	Place of preparation and storage
A:
B:
C:
D:
E:

Comments: