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G. Type of Food Facility Proposed: <br /> choose one of the below <br /> Food Establishment Annual Permit Fee <br /> 16.23 1 —20 Seating C $220 <br /> 16.24 C1 —50 eating Capacity $220 <br /> 16.25 i apaclty $220 <br /> 16.26 101 + Seating Capacity $220 <br /> Food Processing Establishment without Seating Capacity $220 <br /> 16.12 1 —500 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 0 <br /> $5 <br /> 16.20 < 25 Total Square Feet (Incidental Foods) $ 5 0 <br /> 16.16 < 1,000 Total Square Feet <br /> 16.17 > 1,000 Total Square Feet(Food Prep Area) $200 <br /> 16.19 > 1,000 Total Square Feet(W/Multiple Depts.) $220 <br /> 16.15 <2,000 Total Square Feet (Prepackaged Only) $150 <br /> 16.18 >2,000 Total Square Feet(W/Prepackaged Only) $200 <br /> 16.80 Commissary (Storage, Major Cleaning - MFPU) $150 <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 /> 16.07 Produce Stand $100 <br /> H. List food(s) to be served and/or provide menu: <br /> � Arvl� i � t � I-{ � S � SALI�ys <br /> I. Operational Information: <br /> Anticipated business hours: Open: Close: <br /> Anticipated number of employees: <br /> J. Additional Information Regarding this Facility: <br /> 6 <br /> EHD 16-01-0Ot <br /> REVISED 02-21-02 <br />