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1. Page 1 - Business/Contact Information This section is complete This section is incomplete
2. Page 2 - Acknowledgements This section is complete This section is incomplete
3. Page 3 - Review and Sign This section is complete This section is incomplete

Page 1 - Business/Contact Information

The 30 Day Transition allows for New Owners of existing food establishments, residence accommodations and school grounds to remain in business for 30 days while the permit application is in the review process and the criteria detailed in the Maricopa County Environmental Health Code (MCEHC) are in compliance.
30 Day Transition FAQs
FAQs
Permit Application Requirement*
1. I will submit the 30 Day Transition Application and Permit Application (see links below) at least 2 business days prior to the ownership change, and pay associated fees.
Application Type*
I am applying for the following permit:
1. Food Establishment
2. Residence Accommodations
3. School Grounds
Food Establishment Permit
Food Establishment Application
Residence Accommodations Permit
Residence Accommodations (Hotels, etc.) Application
School Grounds Permit
School Grounds Application (Public only)
Business Information (Name on Establishment)
Business Name*
Address*
City*
State*
Zip*
Phone*
Business Owner Information (Responsible Party)
Entity Type
1. Sole Proprietorship (Must show lawful presence)
2. Corporation
1. Association
2. Other
If Other, please describe:
Owner/Corporation*
Address*
City*
State*
Zip Code*
Phone Number*
Fax Number
Email Address
Inspection or Plan Review Response Contact
Contact information
1. Please check box if same as above
Inspection Contact Name
Address
City
State
Zip Code
Phone
Email Address
Ownership Change Date*
Ownership Change Date
If applicable, a follow-up inspection will automatically be scheduled at the 30 day expiration date.
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Page 2 - Acknowledgements

Review each item and initial to acknowledge.
Initial*
The new owner agrees to abide by the responsibilities of a permit holder as referenced in the U.S. Food and Drug Administration 2013 Food Code § 8-304.11.
Initial*
There is an adequate supply of hot and cold water in the establishment.
Initial*
There are sufficient plumbing fixtures in the establishment (i.e. hand sinks not leaking and able to provide hot and cold water.)
Initial*
All plumbing fixtures are working properly (i.e. not leaking and able to provide hot and cold water.)
Initial*
There is sufficient equipment to ensure that foods can be cooked to proper temperatures as referenced in the U.S. Food and Drug Administration 2013 Food Code § 3-401.11.
Initial*
There is sufficient equipment to ensure all Time/Temperature Control for Safety Food, Hot and Cold Holding can be maintained at the temperatures as referenced in the U.S. Food and Drug Administration 2013 Food Code § 3-501.16.
Initial*
All food is coming from safe sources.
Initial*
All equipment is working properly (i.e. freezers, refrigerators, hoods, ovens, stoves, etc.)
Initial*
There is no evidence of live insects or vermin activity in the establishment.
Initial*
The following conditions do not exist and if they should happen to occur, the owner/person-in-charge shall cease operations and contact the Department: (a) Fire or activation of the fire suppression system (b) Flood (c) Electrical or water outage (d) Sewage backup (e) Misuse of poisonous or toxic materials (f) Onset of apparent foodborne illness outbreak (g) Gross insanitary occurrence or condition (h) Other circumstance that may endanger public health
Initial*
The facility is not undergoing a major alteration or addition.
Initial *
The new owner agrees not to conduct any food process where a variance or HACCP plan is required in accordance with the U.S. Food and Drug Administration 2013 Food Code §§ 3-502.11, 3-502.12, 8-201.13, 8-201.14 and Subpart 8-103 which has not been issued and/or approved by the Department.
Initial*
The new owner agrees to cease operations should the time between the ownership change and the issuance of the required permit to operate exceeds 30 days.
Initial*
The new owner acknowledges that the fee for the New Permit Application Inspection includes one initial inspection and one follow-up inspection to address any items not corrected during the initial inspection. Additional fees will be assessed for any additional follow-up inspections.
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Page 3 - Review and Sign

Electronic Signature Agreement
Signature of this application certifies the information provided is accurate, there are no known deficiencies at the establishment, and the owner is in compliance with all applicable laws and regulations. In addition, the owner will not operate the establishment until approval is given by this department. Any changes to this application must be submitted in writing to the Department for approval.
Application Acknowledgement*
1. I agree the application is true and correct.
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.
1. 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

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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Page 2 - Acknowledgements

Page 3 - Review and Sign

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