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IQJUUI <br /> 07/29/2002 14:44 FAR <br /> G. Type of Food Facility Proposed: choose one of the below <br /> Annual permit Fee <br /> Food Establishment $220 <br /> 16.23 1 —20 Seating Capacity $220 <br /> 16.24 21 —50 Seating Capacity $220 <br /> 16.25 51 — 100 Seating Capacity $220 <br /> ------j 16.26 101 + Seating Capacity <br /> Fod Processin Establishment without Seatin Ca acit $220 <br /> 16.12 1 --j 00 Total Square Feet $220 <br /> 16.13 501 —1,100 Total Square Feet $220 <br /> 13.14 1,001 +Total Square Feet <br /> Grocery Store $50 <br /> 1620 < 25 Total Square Feet(Incidental Foods) $150 <br /> 16.16 < 1,000 Total Square Feet $200 <br /> 16 17 > 1,000 Total Square Feet(Food Prep Area) $220 <br /> 16.19 > 1,000 Total Square Feet(W/Multiple Depts.) $150 <br /> 16.15 <2,000 Total Square Feet(prepackaged Only) $200 <br /> 16-18 >2,000 Total Square Feel(W/Prepackagedy) <br /> sStorge, Ma or Cleaning-MFPU) $150 <br /> 16.80 Commis <br /> $100 <br /> 16.81 Commissary (Storage, Minor Cleaning -Vehicle/Cart) $100 <br /> 16.90 Satellite Food Distribution Facility $100 <br /> 16.60 Ice Plant $100 <br /> 1607 Produce Stand <br /> H. List food(s)to be served and/or provide menu: <br /> I. Operational Information: <br /> Anticipated business hours: Open: Close: 3 l e v <br /> Anticipated number of employees: <br /> J. Additional Information Regarding this Facility: <br /> 6 <br /> PHO 16-01-001 <br /> REVISED 02.21-02 <br />