2. Have you filled out and been approved for a mobile food vending operation permit through the City of Waynesboro in the current calendar year?*

   1. Yes
   2. No
4. If Yes:
   Fire Safety Inspection Request

   If you have already applied and been approved for a mobile food vendor permit during the current calendar year, and there have been no changes to the mobile food vending operation or vehicle already approved, you do not have to fill out this application again. If you are setting up at a special event, select this link to request a safety inspection for your mobile food vending operation at the event.
6. Business Information
8. Permit Type*

   1. Pre-packaged foods
   2. Open foods
9. Business Type*

   1. Proprietorship
   2. Partnership
   3. Corporation
11. Business Name*
13. Business Address*
15. Address2
17. City*
18. State*
19. Zip*
21. Facebook Page
22. Twitter Handle
24. Mobile Unit Information
26. Unit Type*

    1. Motor Vehicle
    2. Push Cart
    3. Trailer
    4. Tent / Canopy
28. Make
29. Model
30. Year
32. Color
33. License Plate
34. State
36. Certificate of Flame Resistance
    For Tent / Canopy: Please attach the Certificate of Flame Resistance
37. Tent / Canopy Floor Plan
    For Tent / Canopy: Please attach the overall tent layout (floor plan) showing where items will be located within and around your tent.
39. Type(s) of Food*
40. Number of Employees*
42. Will your mobile food preparation unit be towed by an additional vehicle?*

    1. Yes (please provide additional information below)
    2. No
44. Tow Vehicle Make
45. Model
46. Year
48. Color
49. License Plate
50. State
52. Contact Information
54. Primary Owner First Name*
55. Primary Owner Last Name*
57. Primary Owner Mailing Address*
59. Address2
61. City*
62. State*
63. Zip*
65. Primary Owner Phone Number 1*
66. Primary Owner Phone Number 2
68. Primary Owner Email *
69. Primary Owner Government Issued ID Number*
    Ex. Driver's License
71. Secondary Owner First Name
72. Secondary Owner Last Name
74. Secondary Owner Mailing Address
76. Address2
78. City
79. State
80. Zip
82. Secondary Owner Phone Number 1
83. Secondary Owner Phone Number 2
85. Secondary Owner Email
86. Secondary Owner Government Issued ID Number
    Ex. Driver's License
88. Additional Responsible Party
    if applicable
89. Additional Responsible Party Phone Number
91. Event Information
93. Multiple Events?*

    1. Single Event - Select if only setting up for a single special event during the calendar year.
    2. Multiple Events - Select if setting up for more than one special event during a calendar year.
    3. General Annual Operational Permit - Select if setting up as a peddler throughout the City, not at special events only.
95. Single Event Name
96. Single Event Location
98. Single Event Date / Time
    Single Event Date / Time Start Date

    Single Event Date / Time Start Time

    —

    Single Event Date / Time End Date

    Single Event Date / Time End Time
100. Multiple events: please list all to include dates, times, and locations:
102. Additional Information
104. Are you preparing oil/grease producing foods?*

     1. Yes
     2. No
105. What fuel is being used for cooking?*

     1. LPG
     2. CNG
     3. Other** (Please describe)
106. ** If Other, please describe
108. Please submit a copy of valid business license*
109. Please submit copy of certificate of liability insurance*
110. Please submit a copy of Virginia Department of Health permit*
111. Please submit a copy of the property owner's consent*
     *Must be on company letterhead and have the owner's signature.
113. Does your mobile food vending unit have a hood suppression system?*

     1. Yes
     2. No
114. Please submit a copy of most recent hood suppression system inspection report
116. Please review:
     Mobile Food Preparation Vehicle Information
118. Acknowledgement*

     I attest the information provided is complete and accurate. I have reviewed the attached information sheet, and I acknowledge and agree to comply with all applicable requirements of the Virginia Statewide Fire Prevention Code (SFPC) and the referenced NFPA standard. I also acknowledge that if a permit is issued it shall be valid only at the location listed on the application and for the specific date(s) and time(s) for which it is issued. If approved to proceed, I acknowledge that such approval is conditional upon continued compliance with the SFPC. I further acknowledge and understand that any SFPC violations identified after approval to proceed may result in denial of final permit issuance or immediate suspension or revocation of a permit.

     1. I agree
Leave This Blank:


120. 1. Receive an email copy of this form.
121. Email address

     This field is not part of the form submission.

122. Submit

* indicates a required field