Application for Temporary Food Service Permit

Temporary Food Service Permit Application
Is the address where food will be served within the limits of the Municipality of Anchorage?*

Yes, food will be served within the Municipality of Anchorage.No, food will be served outside of the Municipality of Anchorage.
Incorrect Application

The State does not permit temporary food service within the Municipality of Anchorage.

A temporary food service permit from the Anchorage Health Department's Food Safety and Sanitation program is required.
Is this permit application for one of the following events?*

Alaska State Fair (Palmer)Tanana Valley State Fair (Fairbanks)Tanana Valley Farmers MarketNo, this permit is not for any of the events listed above.

Temporary Food Service Permit Application
Directions
1. Review the information included in the links below
  - Temporary Food Service Requirements (REQUIRED)
  - Review this information; permit applicants must certify that they are familiar with this section of the Alaska Food Code and will operate in accordance with the regulations
  - Temporary Food Service Checklist (REQUIRED)
  - Read this prior to completing and submitting a permit application
2. Complete the application, review, and submit
3. A confirmation email will be sent to the email address listed
4. Staff from Food Safety and Sanitation will follow up regarding approval and payment

Operator Information
Booth or Organization Name*
Responsible Person*

First NameLast Name
Phone Number*
Fax Number (optional)
Mailing Address*

Street Address

Street Address Line 2

City or CommunityState

Zip Code
Responsible Person's Email Address*

Confirmation EmailApplication confirmation and payment emails will be sent to this address

Event or Location Information
Name of Event or Location Where Food Will Be Served*
Address Where Food Will Be Served*

Street Address

Street Address Line 2

City or Community

Zip Code
Name of Event or Location Where Food Will Be Served*
Address Where Food Will Be Served*
2075 Glenn Highway Palmer, AK 99645
Name of Event or Location Where Food Will Be Served*
Address Where Food Will Be Served*
1800 College Road Fairbanks, AK 99709
Name of Event or Location Where Food Will Be Served*
Address Where Food Will Be Served*
2600 College Road Fairbanks, AK 99709

Food Service Information
An approved kitchen is a facility that has previously been approved by the Department or is able to be approved by the Department according to the requirements below.

An approved kitchen:
- IS NOT IN A PRIVATE RESIDENCE;
- Has running water;
- Has appropriate dishwashing and handwashing facilities; and
- Can be inspected, if needed.
Acknowledgment*

I have read the requirements for an approved kitchen.
All food served under this permit must be prepared on-site at the temporary food service booth or at an approved kitchen.
Acknowledgment*

I understand that all food served under this permit must be prepared at the booth or at an approved kitchen.
Food Preparation
Where will foods be prepared?*

All foods will be prepared at the booth.An approved kitchen will be used.
REQUIRED: Attach a copy of the signed agreement for use of an approved kitchen, listing dates, times, and preparation and storage details for the food items.

The agreement can be uploaded in the Document Upload section of this application.

The Food Safety and Sanitation program has an Approved Kitchen Letter of Agreement form that can be used.
Menu Items and Preparation Steps

All foods will be prepared at the booth.
Please list each item on the menu and indicate the preparation steps that will occur at the booth.*
Menu Items and Preparation Steps

Foods will be prepared at an approved kitchen and at the booth.
Please list each item on the menu and indicate where the item's preparation steps will occur, either at the approved kitchen or at the booth.*

Facility Information
Operator Training Requirement
REQUIRED: This permit is four days or longer, so the operator must have an Alaska Food Worker Card or be a Certified Food Protection Manager.

The food worker card or food protection manager certificate can be uploaded in the Document Upload section of this application.
Does the operator meet this requirement?*

Yes, the operator has an Alaska Food Worker Card or is a Certified Food Protection Manager.No, the operator does not meet this requirement.
Facility Operations
Which of the following are you serving? Choose all that apply.*

MeatPoultrySeafoodI am not serving meat, poultry, or seafood.
Where are you sourcing your meat?*
Where are you sourcing your poultry?*
Where are you sourcing your seafood?*
Please include the source and in what form the seafood will be purchased
Where are you sourcing your ingredients? (other than meat, poultry, seafood)*
This includes any ingredients or components of the menu items other than meat, poultry, and seafood.
How are you sourcing and storing water?*
How are you disposing of wastewater?*
How are you storing and disposing of garbage?*
Are you taking it to a dumpster on-site, driving it to the dump after the event, etc.?
Booth Design
How will booth staff wash their hands?*
How will dishes be washed, rinsed, and sanitized?*
How will food be cooked?*
Explain the equipment and methods that will be used for cooking the items on the menu. If no cooking is involved, type "N/A" into this text field.
How will food be cooled?*
Explain the equipment and methods that will be used for cooling the items on the menu. If no cooling is involved, type "N/A" into this text field.
How will food be held at a safe-temperature?*
Explain the equipment and methods that will be used to hold food at safe temperatures during preparation, storage, and service. This includes hot-holding and cold-holding. If no hot-holding or cold-holding is involved, type "N/A" into this text field.
Do you have a food preparation area at the booth? If so, please describe it.*
If there is no food preparation area at the booth, type "N/A" into this text field.
What sanitizer are you using for food contact surfaces? How will you verify the sanitizer is at the correct concentration?*
How will ready-to-eat foods be prepared and handled?*
Explain the equipment and methods that will be used, including the use of gloves, serving utensils, etc.
How will single-use items intended for customers be stored?*
Where will plastic utensils, paper plates, napkins, etc., be stored?

Document Upload
Agreement for Use of an Approved Kitchen*

Required for all organizations using an approved kitchen to prepare food.
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IRS Determination Letter*

Required for all 501(c)3 organizations claiming fee-exempt status.
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Operator's Alaska Food Worker Card or Food Protection Manager Certificate*

Required for all permits that are four days or longer.
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Certification and Payment
I certify that I am familiar with the temporary food service requirements of the Alaska Food Code and the establishment described above will be operated and maintained in accordance with the regulations.
Would you prefer to sign your signature directly on this form or upload an image of your signature?*

Sign directly on the formUpload a signature file
Applicant's Signature*

Clear
Applicant's Signature (Upload Image)*

Cancelof
Estimated Permit Fee
This will be confirmed by FSS staff at time of payment.
Should be Empty:

Permit Length	Permit Fee	Permit Application Deadline	Late Fee*
1 day	$35	At least 7 days prior to the event start date	Permit fee is doubled
2-3 days	$65	At least 7 days prior to the event start date	Permit fee is doubled
4-7 days	$90	At least 7 days prior to the event start date	Permit fee is doubled
8-28 days	$120	At least 15 days prior to the event start date	Permit fee is doubled
Fee-Exempt	No fee	Refer to deadlines above, deadlines are assessed according to event length	Original permit fee is applied, see fees by event length

Temporary Food Service Permit Application

Temporary Food Service Permit Application

Directions

Food Preparation

Menu Items and Preparation Steps

Menu Items and Preparation Steps

Fee Schedule

Permit Details

Permit Fee

Fee Calculation - HIDDEN

Operator Training Requirement

Facility Operations

Booth Design