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Food Establishment Permit Application-Marshal’s Office Environmental Health 1400 Schertz Parkway Schertz, TX 78154 210-619-1650 Schertz.com Environmental Health Food Establishment Permit Application PLEASE FILL OUT ALL INFORMATION: ESTABLISHMENT NAME: ________________________________________________________________________________________________ STREET ADDRESS: _______________________________________________________________________________________________________ CITY, STATE, ZIP CODE: __________________________________________________________________________________________________ BUSINESS PHONE NUMBER: _____________________________BUSINESS FAX NUMBER: __________________________________ CORPORATE/OWNERS NAME: __________________________________________________________________________________________ ADDRESS: _______________________________________________________________________PHONE: ________________________________ CITY/STATE/ZIP CODE: _________________________________________________________________________________________________ EMAIL ADDRESS: _________________________________________________________________________________________________________ OWNER DRIVERS LICENSE OR BUSINESS FEI #: ______________________________________________________________________ ATTENTION: ____________________________________________________________PHONE: ________________________________________ PROPOSED NUMBER OF EMPLOYEES: _____________________ *Permit fees are based on the total number of all employees including management and owners* Number of Employees Annual Fee 1-3 Employees $150.00 4- 6 Employees $285.00 7-10 Employees $540.00 11-20 Employees $575.00 21+ Employees $725.00 NON-PROFIT TAX ID NUMBER: _________________________ $100.00(IF APPLICABLE, PLEASE SUBMIT COPY) *FOOD ESTABLISHMENT PERMITS EXPIRE SEPTEMBER 30 EVERY YEAR* In order to update Food Establishment files, please return a copy of this invoice along with your payment and a copy of your liquor license if applicable to our office at City of Schertz, Marshal’s Office 1400 Schertz Parkway, Schertz, TX 78154. This information must be in our office before your permit can be issued. Periodic request for employee lists, and food handler card verification status will be conducted throughout the year. Please mail payment, this invoice and applicable liquor license/tax forms to: City of Schertz Marshal’s Office, Schertz, TX 78154 _________________________________________________________________________________________ All of the information contained in this application is true and correct to the best of the applicant’s knowledge and belief. Applicant acknowledges that the permit applied for shall be subject to all provisions of the orders and ordinances of the City of Schertz and shall be subject to all provisions of the statues and rules adopted under the statues of the State of Texas governing food service establishments. Applicant Signature: _____________________________________________________________Date: ____________________ Office use only-Permit#: ____________________________ Date Pd.: ______________________________________ Ck/CC