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Special Event Coordinator Event Registration Form/Application (Web Form)

  1. Maricopa County Seal for Web Use

  2. Special Event Coordinator Event Registration Form

    Maricopa County Environmental Services Department
    Environmental Health Division
    Permitting Services Program
    Phone: (602)506-6978
    specialevents@mail.maricopa.gov

  3. Walk-in:

  4. 1645 E Roosevelt Street (West End of Building) Phoenix, AZ 85006

  5. ****A waiver of fee may be granted to the operator of an establishment, which maintains a current 501(c)(3) tax exempt designation from the Department of the Treasury, Internal Revenue Service, who demonstrates to the Board of Health that payment of said fee will cause financial hardship. Please contact the Department at 602.506.6616 for further information.

  6. Event Information

  7. (please indicate the date and time when food vendors will serve food)

  8. (please provide full unabbreviated event name)

  9. Cell phone is preferred.

  10. Is a vendor meeting planned?*

  11. Property Owner Information

  12. The Maricopa County Environmental Health Code requires the property owner of an event location, or his/her designee, to register any event with the Environmental Services Department at least 30 days prior to the start of the event. Additionally, it is the property owner's responsibility to ensure that all food service vendors have obtained all applicable Department permits. Failure to do so may result in legal action against the property owner and/or their designee.

  13. General Information

  14. Will an approved potable water source be provided onsite for vendors?*

  15. Will wastewater disposal services be provided onsite for vendors?*

  16. Will grease/oil disposal services be provided onsite for vendors?*

  17. Will trash/refuse disposal services be provided onsite for vendors*

  18. Will an electricity source be provided onsite for vendors?*

  19. Will back-up refrigerated storage be provided onsite for vendors:*

  20. Will animals be present at the event (petting zoo, rodeo, etc.)?*

    Please be aware that a mobile food establishment shall not be located within 100 feet of any petting, riding or holding area for animals unless dust and runoff are controlled.

  21. Restroom facilities:*

    Temporary toilet facilities shall not be located within 25 feet of any mobile food establishment.

  22. Do you have a dust control plan?*

    Having a plan in place for inclement weather is encouraged. Food/beverages must be protected from dust/other contaminants at all times.

  23. Are parking/entry passes needed for inspectors to gain access to the event?*

  24. List must include all food/beverage vendors including any promotional vendors offering samples. The list must also include all business names, owner names, addresses, phone numbers, menus, and permit numbers (if applicable).

  25. 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.

  26. I agree the application is true and correct.

  27. Once our staff has reviewed your form you may receive a follow-up email/call to clarify details provided on this form.

  28. Leave This Blank:

  29. This field is not part of the form submission.