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Micro Market Permit Application (Web Form)
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Steps
1.
Page 1 - Instructions for Submission
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This section is incomplete
2.
Page 2 - Contact Information
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This section is incomplete
3.
Page 3 - Permit Questionnaire
This section is complete
This section is incomplete
4.
Page 5 - Review Notice
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This section is incomplete
5.
Page 6 - Review Disclosures
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6.
Page 7 - Review and Sign
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Page 1 - Instructions for Submission
Micro Market Permit Application
If you need assistance, please contact us or visit one of our locations.
Office Locations
Follow all instructions below to avoid delays in the application review process.
Application Steps
1. Fill out and submit your application .
2. Our office will review the application, assess fees, and coordinate an onsite inspection.
3. Once qualified for a permit, pay permit fees (online, in person, over the phone, fax, or by mail).
Checklist for review
Complete Application (please indicate n/a, if not applicable rather than leaving empty boxes on the application)
Proposed Menu(s)
Proposed Layout
Cut Sheets/schematics of all equipment to be installed; including any custom built equipment
Shared Restroom/Mop Sink Agreement (if applicable)
Micro Market Guidance
Micro Market Guidance
Fee Schedule:
Fee Schedule
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Page 2 - Contact Information
Business Information (Name on Establishment)
Business Name
*
Address
*
City
*
State
*
Zip
*
Phone
*
Business Owner Information (Responsible Party)
Entity Type
*
Sole Proprietorship (Must show lawful presence)
Corporation
Association
Other
If Other, please describe:
Owner/Corporation
*
Address
*
City
*
State
*
Zip Code
*
Phone Number
*
Fax Number
Email Address
Mailing/Billing Information
If same as above, please check box.
Owner Name
Address
City
State
Zip Code
Phone
Fax
Email Address
Inspection or Plan Review Response Contact
If same as above, please check box.
Inspection Contact Name
Address
City
State
Zip Code
Phone
Email Address
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Page 3 - Permit Questionnaire
Reference Plan #:
Please provide the permit # if the same owner and equipment was previously approved.
How many locations are being applied for with this application?
List of all locations where micro markets will be located.
Please provide address and specific location where market is located (e.g. floor, suite, room, etc.), location contact name and email, and mop sink location. Please upload to the cloud drive (instructions below) if file size exceeds 20MB.
Proposed menu/items provided in machines
Please provide menu(s). Please upload to the cloud drive (instructions below) if file size exceeds 20MB.
Equipment cut sheets/schematics
Please provide equipment cut sheets for all equipment to be installed. Please upload to the cloud drive (instructions below) if file size exceeds 20MB.
Electronic Delivery of Plans/Supporting Documentation
I will deliver hard copy.
Deliver hard copy to the Department if not able to attach here or in the cloud drive (instructions provided below). Please provide the layout and plumbing/finish schedule for all projects involving construction/review. Please be advised that the documents must be legible to avoid delays in the review process.
Plan Review Cloud Drive
Link to the cloud
Please use this link to upload files for plan review (layout).
Instructions for uploading files to the cloud:
Instructions
Please ensure you follow instructions to ensure application is processed and reviewed without delay.
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Page 5 - Review Notice
ARS § 11-1604. Prohibited acts by county and employees; enforcement; notice
A county shall not base a licensing decision in whole or in part on a licensing requirement or condition that is not specifically authorized by statute, rule, ordinance or delegation agreement. A general grant of authority does not constitute a basis for imposing a licensing requirement or condition unless the authority specifically authorizes the requirement or condition.
Unless specifically authorized, a county shall avoid duplication of other laws that do not enhance regulatory clarity and shall avoid dual permitting to the maximum extent practicable.
This section does not prohibit county flexibility to issue licenses or adopt ordinances or codes.
A county shall not request or initiate discussions with a person about waiving that person's rights.
THIS SECTION MAY BE ENFORCED IN A PRIVATE CIVIL ACTION AND RELIEF MAY BE AWARDED AGAINST A COUNTY. THE COURT MAY AWARD REASONABLE ATTORNEY FEES, DAMAGES AND ALL FEES ASSOCIATED WITH THE LICENSE APPLICATION TO A PARTY THAT PREVAILS IN AN ACTION AGAINST A COUNTY FOR A VIOLATION OF THIS SECTION.
A COUNTY EMPLOYEE MAY NOT INTENTIONALLY OR KNOWINGLY VIOLATE THIS SECTION. A VIOLATION OF THIS SECTION IS CAUSE FOR DISCIPINARY ACTION OR DISMISSAL PURSUANT TO THE COUNTY'S ADOPTED PERSONNEL POLICY.
THIS SECTION DOES NOT ABROGATE THE IMMUNITY PROVIDED BY SECTION 12-820.1 OR 12-820.02.
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Page 6 - Review Disclosures
No persons shall commence construction unless the required plans have been approved. It shall be the full responsibility of said person that construction is done in conformance with the approved plans and specifications.
The approval of plans and specifications shall lapse and become invalid one year from the date of approval unless a substantial portion of the work described in the plans and specifications has commenced by such anniversary date. An approval of plans and specifications can be renewed for one year if an application for renewal is submitted within 180 days prior to expiration and a fee equal to one-half (1/2) of the flat fee or initial plan review fee is paid. The approval will be effective for one year from the date of expiration.
Should it be necessary or desirable to make any material change in the approved plans and specifications, revised plans and specifications shall be submitted to the department for review, and approval shall be obtained before the work affected by the change is undertaken. Once submitted, the plans will be review for compliance with the Maricopa County Environmental Health code (MCEHC). A response letter will be drafted and delivered to the applicant using the method indicated on the application. The letter will indicate items of noncompliance that need to be addressed during the construction of the establishment.
Approval of these plans and specifications by this Regulatory Authority does not indicate compliance with any other code, law or regulation that may be required--federal, state, or local. It further does not constitute endorsement or acceptance of the completed establishment (structure or equipment). A pre-operational inspection of the establishment with equipment in place and operating will be necessary to determine if it complies with the Maricopa County Environmental Health Code governing establishments.
A “grandfather” clause or provision is not provided for in Maricopa County Environmental Health Code. All establishments under new ownership, newly built, or remodeled shall meet current construction, equipment, facility, and operational regulations as adopted and provided for in the Maricopa County Environmental Health Code, guidelines, and procedures, and policy statements. A permit shall not be issued to a facility for which a permit is required, and shall not be allowed to operate until the applicant demonstrates to the Department full compliance with applicable provisions of the Maricopa County Environmental Health Code. Any construction, alteration, or addition shall be made in accordance with specifications approved by the Department. The owner, operator, or authorized agent shall certify in writing that the establishment will comply with these regulations. On-site inspections of the facilities and premises with equipment in place and operating will be necessary to determine compliance with the Maricopa County Environmental Health Code.
Delivery of Inspection Reports
Pursuant to A.R.S. § 41-1009, the Department may enter your establishment to conduct inspections. You have the right to receive a copy of the Department's inspection report at the time of the inspection, within thirty (30) days after the inspection, or as otherwise provided by federal law. I agree that the Department may send me a copy of its inspection report by e-mail or by facsimile transmission to the e-mail or fax number provided under the Business Ownership Information provided above. It is the responsibility of the permit holder to update the Department if there is a change in contact information.
Disclosure Acknowledgement
*
I have reviewed the notice and disclosures.
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Page 7 - Review and Sign
I hereby certify that the above information is correct, agree to comply with the Maricopa County Environmental Health Code, agree to allow the regulatory authority access to the establishment as specified under § 8-402.11 and to the records specified under §§ 3-203.12 and 5-205.13 and Subparagraph 8-201.14(D)(6), and I fully understand that any deviation from the above without prior permission from the Maricopa County Environmental Services Department may nullify final approval. By checking the check box and typing your name you have digitally signed this application.
Application Acknowledgement
*
I agree the application is true and correct.
Arizona law, A.R.S. § 11-1605(I), allows Maricopa County Environmental Services Department (MCESD) and the applicant for a license to mutually agree to extend the plan review time frame by 50 percent of the substantive time frame and overall time frame. MCESD will agree to any applicant's request for an 50 percent extension of the substantive review time frame and overall time frame when box is checked and signed below.
Licensing Time Frame Extension Acknowledgement
I agree to the 50 percent extension.
Electronic Signature Agreement
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.
I agree.
Disclaimer
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.
Electronic Signature
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Email address
This field is not part of the form submission.
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