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HomeMy WebLinkAboutReport 1CITY OF RENTON DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT MEMORANDUM Date: September 26, 2013 To: City Clerk's Office From: Lisa McElrea Subject: Land Use File Closeout Please complete the following information to facilitate project closeout and indexing by the City Clerk's Office Project Name: A Fire Inside: Mobile Food Vendor Temporary Use Permit LUA (file) Number: LUA-13-000539 Cross-References: AKA's: Project Manager: Kris Sorenson Acceptance Date: May 3, 2013 Applicant: Kelly Carner Owner: Mclendons Hardware Contact: Kelly Carner PID Number: 1823059118 ERC Decision Date: ERC Appeal Date: Administrative Approval: May 3, 2013 Appeal Period Ends: May 17, 2013 Public Hearing Date: Date Appealed to HEX: By Whom: HEX Decision: Date: Date Appealed to Council: By Whom: Council Decision: Date: Mylar Recording Number: Project Description: Mobile vendor, wood-fired pizza, to locate under eave of Mclendon Hardware south of Top Pot vendor. Location: 440 Rainier Ave S Comments: DEPARTMENT OF COIVrnllUNITY AND ECONOMIC DEVELOPMENT PLANNING DIVISION TIER 1 TEMPORARY USE PERMIT ~ APPROVAL O DENIAL DATE: PROJECT NUMBER: PROJECT NAME: PROJECT MANAGER: OWNER: APPLICANT: CONTACT: PROJECT LOCATION: DATE OF EXPIRATION: EVALUATION FORM & DECISION May 3, 2013 LUA13-000539, TP A Fire Inside: Mobile Food Vendor Temporary Use Permit Kris Sorensen, Associate Planner, {425) 430-6593 Mclendons Hardware Renton Attn: Manager Bill Haytack 440 Rainier Ave S Renton, WA 98057 Kelly Carner A Fire Inside 11135 SE 1161h St Renton, WA 98055 Kelly Carner -A Fire Inside, {206) 992-5394 440 Rainier Ave S May 4, 2014 PROJECT DESCRIPTION: The applicant proposes to locate a mobile food cart at a site along Rainier Avenue next to the Mclendons Hardware building front fa~ade. The vending unit is a trailer and would be set-up to offer walk-up food service. Food service would be generally provided Saturday through Monday between 11:00 am and 7:00 pm. Surface parking for customers would be provided at the same location and vehicular ingress and egress to the site is accessed from Rainier Ave S, S 3rd Place, and S 4th Place. - The following Tier 1 Temporary Use Permit is hereby approved and subject to the following conditions: City of Renton Department of Community & Economic Development A Fire Inside: Mobile Food Temporary Use Permit DATE OF PERMIT: May 3, 2013 CONDITIONS OF APPROVAL: Administrative Temporary Use Permit LUA13-000539, TP Page 2 of3 1) A City of Renton Business license must be obtained prior to operation. The applicant has applied far a Business license, date April 29, 2013, with a review time of 2 weeks. Code Enforcement and the Planning Division see na reason the application will be turned down at this time. Temporary allowance of operation is granted. Operation must stop if the business license application is denied. 2) All requirements, standards, and permits required of the Seattle -King County Public Health Department must be met ond approved prior to operation. 3} The mobile food vending unit, A Fire Inside, cannot stay at the location permanently and must move daily from the property between 12:00 am (midnight} and 5:00 am, except for a special event where the unit is allowed a the same location for up to 72 hours. 4) The site occupied by the temporary use shall be left free of debris, litter, or other evidence of the temporary use upon completion of removal of the use, or when the operation of the use ceases to exist. 5) The site occupied by the temporary use shall be restored to the original condition when the use ceases to exist including restoration of site elements such as, but not limited to, landscaping vegetation and parking stall striping. DATE OF DECISION ON LAND USE ACTION: SIGNATURE: ~-~·~:t.( RECONSIDERATION: Within 14 days of the decision date, any party may request that the decision be reopened by the approval body. The approval body may modify his decision if material evidence not readily discoverable prior to the original decision is found or if he finds there was misrepresentation of fact. After review of the reconsideration request, if the approval body finds sufficient evidence to amend the original decision, there will be no further extension of the appeal period. Any person wishing to take further action must file a formal appeal within the 14-day appeal time frame. EXPIRATION: A Temporary Use Permit is valid for up to one year from the effective date of the permit, unless the Community & Economic Development Administrator or designee establishes a shorter time frame. City of Renton Deportment of Le ... munity & Economic Development A Fire Inside: Mobile Food Temporary Use Permit DATE OF PERMIT: May 3, 2013 Aw11mlstrative Temporary Use Permit LUAl3-000539, TP Page3 of3 EXTENSIONS: An applicant can request that a permit be valid beyond the one year expiration, for up to five years at the time of application or prior to permit expiration. Extension requests do not require additional fees and shall be requested in writing prior to permit expiration to the Department of Community & Economic Development Administrator. APPEALS: Appeals must be filed in writing, together with the required fee to the City of Renton Hearing Examiner, City of Renton, 1055 South Grady Way, Renton, WA 98057 by 5:00 p.m. on May 17, 2013. RMC 4-8-110 governs appeals to the Hearing Examiner and additional information regarding the appeal process may be obtained from the City Clerk's Office, (425) 430-6510. 128 0 64 128 NAD _ 19B3_HARN_StalePlane_Washington_ North_FIPS_ 4601 Feet tf ~:-f ~/.t.:::.~ :: }::'?tt:;f .. ' t· ·,Jl!J!l,T. ·, /;;·;•:··· .. '§f.:::.'. ·:;.· Information Technology~ GIS RentanMapSupport@Rentonwa.gov 01/24/2013 This map /s a user generated stall~ output from an Internet mapl)Jng site and Is for reference only. Data layers that appear on this map may or may not be accurate, current, or otherwise reliable. THIS MAP IS NOT TO·BE USED FOR NAVIGATION Legend Jurisdiction Boundaries [] Other (1 City cf Ren1on Addresses Parcels Environment Designations II Natural • Shoreline High Jnten1lty [J Shcl'llllne. l1olaled High lntan1lty ' • . Shoreline RHld11nUid II] Ufban Conservancy Jurisdictions Stre8ms (Classified) 2 3 4 '> ~ .... s ,::. 1:1,542 . (') -0 -· ~~ ;,. 9.. ::> 0. (t) 5. "::) </! ..... o 0 ~eIT[on~l Finance & IT Division . -i City of Renton .1 Reotol'1 'i't\/ 'J . ,., ' f"1ivir~:on :-:ii,::,c_n\n;! ·· · , .. _. LAND USE PERMIT ··i-·:i !\ i'•' () i 'i\_; \ "f-\' • MASTER APPLICATIOlt"~ ~ 115) \1 \1 L~~ _,, PROPERTY OWNER(S) PROJECT INFORMATION . I ~M."f} {if' PROJECT OR DEVELOPMENT NAME: NAME: !Jc/cAJck1" t3i' II tJ.lfJ.11,:W< ( (?fl} L <1.'f I 'nN t'rmYo-, . PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE: ADDRESS: Lfti(/) /?.r;)~t!f' /)..U( 5 lf40 R 14-, )<ii ev, !l-U C. 3' CITY: R-eAJrotJ. LJA-ZIP: °lo05 7 f?y>JV'oN lJ A Cf f 0'5"'7 4) -S -J 3 5 -"] 553 KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S): TELEPHONE NUMBER: APPLICANT (if other than owner) NAME: Killlf U4RN&- EXISTING LAND USE(S): ".' PROPOSED LAND USE(S): COMPANY (if applicable): A-·n 'r-e.. J'N'S /de i!/3552 /(~tltJT · EXISTING COMPREHENSIVE PLAN MAP DESIGNATION: ADDRESS: R,wr~ ZIP:9~055 PROPOSED COMPREHENSIVE PLAN MAP DESIGNATION CITY: (if applicable) TELEPHONE NUMBER: 8--() 6-Cff J.-S 3'1'-( EXISTING ZONING: CONTACT PERSON PROPOSED ZONING (if applicable): NAME: K€ll1 CARNliJ?. SITE AREA (in square feet): ~ SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE COMPANY (if applicable): /+ "F(l;y: J:f1J':J, ,J e._ DEDICATED: ADDRESS: 11135 5)J. ((/f 7"/1_5f SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS: c1TY: KerJf--O>J UA ZIP:qtoss PROPOSED RESIDENTIAL DENSITY IN UNITS PER NET ACRE (if applicable) TELEPHONE NUMBER AND EMAIL ADDRESS: NUMBER OF PROPOSED LOTS (if applicable) ;)Ob ---Cf 1 J-S' 3 q Lf K:e/ V;'JS1 6Jfrfrt8/J * Cc,t11 NUMBER OF NEW DWELLING UNITS (if applicable): H:\CED\Data\Fonns-Templates\Self-Help Handouts\Planning\masterapp.doc -1 -03111 : i ---I Legend I ' Jurisdiction Boundaries 128 0 64 128 N.A.D _J 983_HAR N_S'.atePlane_Washing1o r. _ North_FIPS_46Qi Feet ~ " I::" •• ir;-440 ·II!' .• Mcl~ntlon Harc!war.e Irie: /'! 1 -;lt':~ ;;,:,_ t i !:i" • 1i .; J J-). ; ' "f: r •S ?, • 'f, Information Technology -GIS RentonMapSupport@Rentonwa.gov 01/2412013 This map is a user generated siatic output from an lnierne1 mapping site and is for reference only. Data layers that appear on this map may or may nol be accuraie, current, or otherwise reliable. THIS MAP IS NOT TO BE USED FOR NAVIGATION r·1 Other [] City of Renton Addresses Parcels Environment Designations ml Natural Ill Sholl!llne High Intensity D Shoreline Isolated High Intensity II] Shoreline Residenijal Qt1 Url>an Conservancy Jurisdictions Streams (Classified) 2 3 4 ,<;. ·,;-- j ~ ,-·~ iJ' 1: 1,542 ··.::; -2 '; -· "" '<.; % C -= • . ..J ~-(I.\ -·· ,:; 'f> .... '2. 0 City of TI ~Qfl tS.il ftc;••L "-~'" Finance & IT Division PROPERTY OWNER'S AUTHORIZATION fpRMn~(Q) (To be completed by owner of property business is requesting to cond~fi'~k~s at) Date l/13/12 STATE OF WASHINGTON ) COUNTY OF KING ) I signed and sworn to (or affinned) before me on _____________ by ________ _ Notary Public in and for the State of Washington Notary (Print) ____________ _ My appointment expires: _________ _ Dated: _____ _ FfNbl-04 03/16/2012 Do it Right, Serve it Safe -Print Card & Receip Public Healthl"'fl Seattle & King County~ Washington State Food Worker Card (~) Health Officer ~ .... &dl,o ..... Kiog Counly~HMIII ..... Receipt Transaction Date KELLY G CARNER II IIIIIMITTiilliiililffif iillll 1111 1152703K6CNPXFC1 03/27/2013 Transaction Time 7:13:00 PM Name of Card Holder : Kelly G Carner Transaction Type ONLINE https://www.foodw -rcard.wa.gov/payment/reports/printaspx?unid ... Transaction# Card Issued To Card# : A-f7d96a1S-22b3-437e-aa6c-976e0dfad3fe : KELLY G CARNER Card Expiration Date Payment Amount 1152703K6CNPXFC1 03/27/2015 $10 • If you have completed additional comprehensive food safety training approved by the State of Washington you may be eligible for a food worker card that is valid for 5 years. Please contact your local health department for details. Do it Right, Serve it Safe -Print Card & Receipt https://www.foodworkercard.wa.gov/paymenVreports/printaspx?unid ... nf 1 Public Healthl•fl Seattle & King County~ Washington State Food Worker Card (•l;nahn) LAUREL Y SIMMONS Health Officer PIM!: ....., s..• .... Ka; eount,Emhlaa..ilfNIII ...... 1111,,,1001irnl1mrn1,1,~1f iii 11111, 1151D04LXMA6M4S1 Receipt Transaction Date 04/10/2013 Transaction Time 8:09:46 PM Name of Card Holder : Laurel Simmons Transaction Type ONLINE. Transaction# Card Issued To Card# Card Expiration Date Payment Almunt : A-13aa7893-b.2cQ-4336-879e-8217cd57851 C : LAUREL Y SIMMONS : 1151004LXMA6M4S1 04/10/2015 : $10 • If you have completed additional comprehensive food safety training approved by the State of Washington you may be eligible for a food worker card that is valid for 5 years. Please contact your local health department for details. 4/10/2013 8:10 PM \.._--.;,._,·y..--•.'.---·-,--·---'--~,. --. ·-----------·~-----r·:"1'··;r--7,.-.; ,.~ ;p7·•~0, ~ · /ct Establishment Inspection Report ;f=orm C ~ r,) \ II ';) ? llc'Z. Public Healthl•t, Seattle & King County D ("' '/ " . '\ -u,-.1'.. i1.1." -Lnr\ ,A.isiness Name: Operator: ,,· ~EfJl I,~•.· pf I A Fi ll. lrSi,lc. \Joo A fi /t,\ \>i ,7." ;I · • \)i,11s10D '}<,-,nf'.',f\9 · Address City ZIP Seats I Checkouts t-'none: I ( .L. ·:;•,\\~ General Health Record ID P/E Date Time In -,, ·• Office Time Activtt\l'·Tir!ie' Travel Time PRI I I I I I I I I IG 11 1~ I:. I luilll1.lrl 1 11 I ID : i1;.~m :;1~ m . : m · .. ,,..;1n1 m 11: . • . ... • • ,,~~~iWl1 Item Number Violations cited In this area must be corrected with the time frame specified. 11> 1280Scheduled 1" G(F; c e. (o 11"" 1 l-7, r)i,-v, i< 1290 Return 1260Fld Pl Rvw 130 0 Complaint $ ( u~i. C hc..-,,i: oL oiv ~, ,-d .. i P t> i c.,,, t,rfrovt'A \>'D \.,,\ !. f \ J..°1.A \-Y'' I\(,,... 1330 Illness /lnj. 1340 Permit Inv. C'lV'l~I C \...""Sc o/_. (O MMl!S M'J. 136 0 Field Educ. -127 0 Pre-Operat. 1060HACCP -n,, i ~ .:r'--h, ,\ 0 0 . 1:i, 0 (Oh, pll )-(. ri,L LI se. b j... ( 0 M "'15$t, f-1 f-u ( )'\'> c, "'' v, r, "'l Results 01 0 Satisfact ,1-5,4,,-,n\ b-( bo J\.. ..._, {)1,., vi "'.l \nl ( LJ Iv' MI >1,J--( / ow Y\ d,,.... ' 02 D Unsatisfact. 1-:) S cd,, "', )' \'I,.,{_ h, l\v,"'".'.l '. 03'8'C,omplete 04 Dfncomplete 0 Ar PI, r"' hv" I" O\"t,....,, 1-e I,.. ).Ac ~1) <. h> od \.,\ "' \-I {t;w.r,-,,!,S /..,J "-/ D @) p '"-'I )\-,l Fie It\ p l " .... l(ev1 e.,J (}e "' g-LIO/.. Action fl/' I~' IL ll." \-~ee. "' ~ <;?Di 04 0Suspend 07 D Approved (1 "'-,,s,~;c) \" Pr' i,,.,i {-, ( .,. ,; 'I. 11 l 10 D Disapprv'd fo)--:,, ! \)s,' I 'I S-J . 26 D FoVup Rq'd ' s. D /3) ~\Jlc v, VI . Trans Fat 0 }1/1 0 bt \e_ h!Vi\ L\1,1'>-<;, k Lv(""''"• () ("' µ. u-.-\ l-t-(I"'"'.\{_ 7130 0 May 2008 (i) h! 0 (\ t>~ ft, r" h lV, \=I v>w c\~"1:.. 7140 0 Feb 2009 7150 0 Documnts Nutrition \)\5(,,£.V,l \, v, ,' \ t\ I "', . "\ l,\A ,.-/)v,.m ,d ""'"' ,S~''l '\'.drko, \,'P/" '\'., ll, Labeling · 7200 0 Applies \he. \c, \<I, r.-.. i 5, 1,:' ),-& "' )., h,)... \.,,,t->, hPVI'.,,.... \A SI"'/\. lh,vc r r u'i u rl 72200Menu c, \-,I " ~ \1 (>, 1"' 'j. ;, l ( p \ "',~ \, ,;-J \ . 7230 0 Menu. Bd (I-~ f"r'"'• ~ (Ap~nv• :r. \-7240 0 Pt of Order A1 ,1,: 1-·.,.,, f ,, , .. )-:,t-..,1,\i"\ yPf' "''), kt ( t, 1a.Sc.. \ l--v10S \P J ~ 7-00 _<;,\ f., /_ . 7250 0 Statement -7260 0 Review -'I r' r1l fDS,1;-~ )-v \) >l. C rec.r1Jc.. I[,' rt hr" 'W ,-nc !S l" '\7 r," hr,-\,~ J Re·d Criticiil Points Comments Ci,.-, \)-of,! D ph-I Off,.-<-k. ~,,,... \,e,.51 \.,( 5 S D G,\\v~ \h( q b O ,-C. ~ \;i Per. S, II\\, >-1 If<,\ Oft.. .,\ b f'l,e '-( l ~ "" \h <. h el 1\ y/Ar, Blue Points "') -ftv·\t0 ' . . Based on an inspection this day, the above items are violations, which must be corrected in the time specified by the health officer. A food establishment permit may be suspended without warning, notice or hearing tt the requirements qf the food code and/or directives of the health oHicer are not met or if violat_ions are not corrected in the time stated in this Total Points report. The permit will be suspended tt an imminent hazard exists or there are 90 or more red critical points or ii there are 120 or.more to!al points. The health officer will provide an opportunity for an appeal on the valldity of a suspension or the findings of an inspection report if a written r~quest is fi!ed with the health officer within len (10) days of the suspension or inspection. The filing of an appeal does not stay the effectiveness of a suspension. The completed Inspection form is a public document that must be made available lo any person who requests it under the provision of the Public Disclo~ure Act (42.17.260 RCW). . · ' /, _I{ j Person in Charge • K{//1,1/lfl!erv Ere (Signature). ~" ~ (Prinled Name) -1... I--! . 7\...- Regulatory Authority (Printed Name) D I c-. C.:..c /\"J (,s H( (Signature) ( \ p-/r~ Public Healthl•fl APPLICATION TO OPER..<\.TE A Seattle & King 1-,'W~w :MOBILE FOOD 1:JNIT/COi\lMISSARY -II'\ tlo,1~~)()\\~ c,\6',iilJ.Db{, . PEnnr YEAR !SAPRIL I"THROVGHM~RCH 31ST C,\ 'I i\Y 01°1· Ne,v! Nmv you can rene\.von-line at http:/iw,n,•.kin'=tcountv .2ov!healthservices/he<1lth/eb#'l'.~spx Appendix H NameofMobileUnit: /Jf/re.1'-(1)<;,cl.<-vJCJcJr.:ln·tJ Pt'ZZ/1 ,t~. ~· :· 1J1~ ~\rill . ,;::,; Owner/OperatorName: . ~..J/Ji _ fr-lqR~/f£ :•,-c: Z·l·P·C·A~~~~~· ·::: MailingAddress: f}/35'.J£f6'-////,'SI City: f,e;..,,fCll\) '\)'"\\~{ DaytimePhone: c}f,J6)':1!11,.-SJqq Email: Kehu'n·5fti)(;jl11).//4 .LQfo) NameofCommissacy: (~Ve k'/YcJ!t!!AJ Worf ;.,-~:,·?0i.'. ~; Commissary Address: J it $ iJ 4,{f[sj('<e.'C.t City: /ftMµ,J ZIP Code: Mobile Unit Operating Location: i_/'{() f<&i,t],tu, f}l!e f'-City: /{'(I,)%}./ ZIPCode: C/'/OS7 If operating on a route or at multiple sites, please fill out and attach the Mobile Vendor Supplemental lnfonnation form. Check all that applv -CChange of O\s.nershii,) Change of mailing address Change of Commissary Classification Chan~e: Change of Business Name Pre,aous Business Name: __ 7i'.i..u,c..5i,' ('-"'A"'l\ .... 1-S_.....'D ... Otll,,.,._,_e__,/?LL·L; ' ... z_z,.__,A'-1'------=======- Notice: By signing this fo , you attest to the accuracy of the information and that you will comply wi1hlilif!Qoi!Eo!\<!e. · SIGNATURE: DA"fi}·it·ff#/'l 7/,q/;'y 5 Call (206) 296-2966 ifyo do not receive a renewal application by Feb1uary 28" Be sure to renew your pennit before it expires. PAYMENT Il\'FOR.iVIATION See back of form for fee schedule and where to submit this application. Check if applicable: Ne\v operation 1 date opened __ I __ I __ Seasonal operation: Date of opening __ / __ / __ Date of closing __ / __ / __ D Check or Money Order, Payable to: SK CDPH VISA 1v!aster Card Discover Card Number: fl lid j>I ~" 1U"1 """' Prorated Mobile Unit Permit Fee Prorated Commissary Permit Fee Late Fee Total Due Check Number I ------ I s Z.4 I I Card Billing Address: --------------~ City: _________ ZIP: ___ _ Card Expiration Date: __ I __ 3 DigitCode(onbackofcard): __ _ ---Required·Signaturtjarnn·erediteard): Mobil,PR Qt) \s:l 4¥ OFtic11:usE··Q!l'LY FA ______ ·· PE.b')'is-'> PLANREVIEWSR ______ _ Commi,sary PR _____ FA _____ PE ___ VARIANCE SR _____ DATEFAC!l!TYOPTh1'D __ ! _ I INSPECTORNAS!E(p,ino) ______ S!GNATURE ______ -e,•·-·.--· .,,.,,,.,..DA'IE=...l"Y~ '.1/;i"~.D I} J,i JI::,! 11.., )!J~ B. " l!,'J L ,J,. 'h .. S.1'.EhshaH·.'T echdataff ood:FoodForms!.2013 food forms -2013 Mobile Food Phm C"'!Jido A.~ilabk in a!terna;iwformat!l.pon requestpur.suan.t .o AD • ..J. A;:.,~ 2 " ,.,.,.,, .} i"\ \; t_i;:(.) EASTGKJE ENVIRONMENTAL HSi\LTi: 13 .:/] Creative Kitche11 Works Th.is is not your Mother~s kitcllen! Phone: 425-251-6%3 Creativek.itchenwork..'®q.com 281 SW 41 <l Street l{l;Jlton) WA 98057 To the attention of: April 24, 2013 This is a letter is to confirm that A Fire Inside will be operating their business out of Creative Kite.lien Works. They will have a storage pa.ntry for. their dry goods and perishables and will also have access to all the equipment and restrooms facility. They will be working 20 hours a month basis - " El\STC,ATE ENVIRONMENTAL HEALTH Food and Facilities Program 401 Fifth Avenue, Suite 1100 Seattle, WA 98104~ 1818 206-296-4632 Fax 20G-296-Dl88 TTY Relay: 711 www_kin9cou11ty.govfhealtl1 Use of Commissary Agreement for Catering \II?-' \\ \ jl.J It is required that the operaUon of a catering business be based from an approved commissary kitc~en or se · \'e.°© area. (Be advised that commissary kitchen use outside of King County will not be allowed.) The com · ·- essential part of a caterer's operation and must have facilities for supply storage, equipment clean preparation and other servicing activities. Minimum plumbing requirements for a commissary includ a 3- compartment sink, a mop sink for dumping We1Ste water, and a hand wash sink. An indirectly drained food preparation sink will be required if produce washing occurs as part of the preparation activity. Plan/Permit approval is contingent upon thorough documentation of the servicing activities to be performed at the commissary. Provide scale drawings of the commissary kitchen showing the food service equipment and storage to be used. (All of these items must be addressed as incomplete plan submittals may delay approval.) Indicate which of the following services will be allowed for use at the commissary: ------------------,---Phone: __________ _ -~----------------City: ______ Zip: ______ _ (Caterer-Printed Name & Title) (Caterer-Signature & Date) '"'This agreement between the owner of the commissary and the caterer signifies that both parties agree to the ~--·at1oweu-oslrnfthe-commissary1!5"specified:-Note1hat1hls-agreementis-not-transferable~snoufd-there--be-a~---- change in ownership of either the commissary or caterer owners, or should there be any modification or cancelation of this agreement between parties, then the Public Health -Seattle & King Pennanent Food Service Establishment Permit may be suspended. · Office Use On/y: CommissafY Suitablli.ty I HEI Concurrence: (Prinwd Name) (Signeture) (Date) Commissary Agreement 2010 Appendh:D Mobile Food Un.it . -· --· ----·-----·----·-· ·--·---~--··-·---·--·· ~-__ .J.?Qpd._£:r:ei:rn:c;itii,n floJ1'_ Cba(t__ .. .. __ ._ _ --··· -· ' -, ~-~~~ . ... -· ---· .. -·· -- NOO~~ Cl.lt( COl)k/ l t(.'l<l . lr.ot ~' I th!IW itSMlll>le b~ffs I C!Ji'll J:iol!1lr.g rchr.,::if fiolcfing pl:'l-ck1,g\! st,):":lg,1- I - Exam~ie: Clam Chowder ,/ ,/ .;' , I v' -- ~tcfJRJJcj,, _ · ·· --, -· . ----r .. , ..... ,. -·l;;"'-1· ---· .. -··· v . ----;----. --·---· .• l.-C.-··-. ., ... -- 2. -~ ' ! .-1' -,,.,'l7',]Ms I 3. dw I --.. I ,~,-,,(;v.s {,,,/ (.,_.,,---· C- ___ _.. =h .. 05.J I /_./"'' ,. . I (._..,--l,/,.r·· ,____......---· ~a~ ·e__rLc-I L---I I l. .. --. I i 1· I I I I I I I Us~ ea.zb menu item and check. mark each foo<l oreparalion step t:11.ii wiil oc-;i-J• at ff,e comni 1saary· ~ ' ---t-----~--------~ir---· i I I I I I i ••.. _,, -L_._ --' ' ~---..... List each menu it~m P.J"td cheok mark eacl1. food ,prepan;,tion step that will occur on the mobile. food unit; 111 ci:.i!d FOOD '. holding rehe~t. hl)t bolding - ~ ~x~plc: Clam cnowder J J I v' ,/ I j ! ,Yuz.::_ -, ,1 1r---+-V"-l-_-+:_-!--'L------.----+---------111 fr+'' ~----r: il I . ------------------JI Jh,-----------------li----f--+--+----+------+------------------------------11 16 I le,,.--------------lf-----------t---+---,--+---+------------·- --~~ij ... '_:_ ~~-:=,-=----=-~--=--=-=---=~11 _---+-----=------1-__ -___ ---1 __ -==-:===I =========i ;f_ J i --~------~l---+-------11 ,I NOTIS, 1f you, prepe.raliM prcce:duci::s C3nriof. fit th~se charts, fl kB~~ list all ofUt~ ~lt..'J)S iq:,rep:iring ei?.-ch mer,u irtm on a separ.ate sb:et. S/Ehsharetrc:chd:r'":.a,lfvod Forrns/2012 food fum1s-Applicaci<,r. fo~ Fll-TI.1e1.s-M.ark.ctlR.evim! 10/J J/1 i A~a.ifable i.r1 c;.lt~rr..a<iw_f.;,;r.wr 1q11.1r2 ie{jll£Sf p1,-rsuu,-u ,'O ADA 8 Public Healthl"'!I Seattle & King County 9n ,.,,, o\ p.e v\ .~ 01~6 100 Mobile Food Unit Site Location or Route Change '?\'.'.\,n,no •i\'."\ ' (\ ' ',, ,. The Mobile Food Unit (cart/vehicle/trailer) owner/operator must notify Public Health for approval each uM~'fhere is a site location change. This requirement applies to those mobile food units temporarily or pennanently relocatin1j s:.nfc:; ID' their operating site location, those changing their daily itinerary, and to those adding occasional addWF,.-~1 wee;~ll('/ ,r;,'YJ and/or Temporary Event sites to their route. Formal Public Health Sealtie-King County Plan Revie~~li!fed, nor is a fee charged. Please complete this form and submit it to one of the following District Offices: · Downtown Environmental Health: 401 5'" Ave, Suite 1100, Seattle, WA 98104 206-263-9566 (Office) 206-296.-0189 (Fax) Eastgate Environmental Health: 14350 SE Eastgate Way, Bellevue, WA 98007 206-296-9791 (Office) 206-296-9792 (Fax) Mobile Food UnllNendor Information: Site Location Change (For one location operations): Proposed new/additional site location address: 41./{J lf&1hr1!,,r /)1Ie5 /(c1J/'C;N ~ :}Y65 7 Date/Time at new/additional location: __ -1.7..£;0£ . .:::-~7£:o::'.!'.o ________________ _ Is this a one time change ora permanent move, explain: _,F"p-"e,"-~==·~"'"'1;-'-f"--'-rl-'-c:.:J.:::'-_;'~=---------- Itinerary Changes (For those operations with mu#iple sftes/routes): Proposed new route (Include dates/times): Location 1: ---------11--.----fff------------------------ Location 2: ________ _,/,+.!-1/----JPll'I. ~------------------- Location 3: ---------1'--'.J--'-fr.,_ _________________ _ I " If more space is needed, then continue on backside of form. t!!t (e. ----~--------- Restroom access for employees is required within 200 feet of the mobile food unit. Those operations with a perrnaneni relocation change, and those with route stops of more than one hour, will require submittal of the Use of Restroom Agreement form (_Appendix E). s,Ehshare/TcchdatalFoodForms/2013 foodforro!'>-2013 Mobile Route Chao.ge Form Available in a!temativr,, jormatupon r-Efjii€S.t ptn·s<.1an; to .).DA I Use of Restroom Agreement All Food Establishments must provide restroom facilities for employees. This fonn shall be completed if Y9't~ll !>,~':using restroom facilities that are owned by someone else. \/If'~ 1 Restroom facilities must be readily accessible within two hundred (200) feet of the food establishment durl~~Q~\Q) operation. In addition, Mobile Food Units must also have access to restrooms if in any one location ~J,llil~ ,\\i\ij hour. The restroom must be provided with adequate hand washing facilities and be fully plumbed toilfylwli rand sewer (or to an approved septic system). Sanlcans/Honey Buckets are not allowed. Running water at the hand wash sink must be 100 'F or more. Plan/Penn it approval Is contingent upon thorough documentation of the accessibility of the restroom. Provide documentation (map/site drawings) noting the route (for mobile food unit) and exact location of the restroom. Indicate the distance In feet from the food service to the restroom. Restroom keys must be provided for employee use of the restroom If the business hours of the food service are different from the business with the restroom. (All of these Items must be addressed and documented ... as Incomplete plan submittals may delay approval.) Indicate which of the following Is available at the restroom location: Hand washing clea_n · -~r B_ar __ s_o_a~-----c:--:----:---.. . Hand drying prov,smn: , sable t\lll,/el? Heat~-arr dry,ng·devtc":::;> Continuous clean towel system " Required sign or poster which notifies food employe'es--to--'wash-thetrl'iands" clearly visible /V l'l· u Key accessibility to restroom (if applicable) e,:_ Distance from food service to restroom (in feet): _L..(.,5'-'o"--'r'-~--'T------------------ Food service hours of operation: __ .,__---'7'---,,-----:----------,----,---,..,-,--,---,- lf seating Is provided, .then a plumbed restroom allowing customer access must be available within 200 feet. Zip: Cf!£D5"7 Mobile Unff!Food Vendor Information: Name of Business: /}-F,'re. "l)v ,,>-Je i, 1nd(J.. 6red 8 Zc,4 Address: // / ']5 l--~-~ City: f<1>;/c,('V Zip: q 9'0.5S: Owner/Operator: {!{r}/'4ui~ Phone: :;;i e,(;--GJq:], -S: 1 '7</ DaysrTim.e at Re~troom: :?3l!t':;f:/'/(' 7-- Email: K-e.,/Ui55'i@C_l_(c,_ (Restroom owner/A ent -Printed Name & Title) rx. . (Restroom owner/Agent -Signature & Date) This agreement between the owner/agent of the restroom and the owner/Vendor of the food establishment signifies that both parties.agree to.the.allowed .use of .the . .re.stroom. facilities as specified. Note that this agreement Is not transferable. Should there be a change In ownership of either the restroom or food l!stabllshment, or should there be any modification oi-cane elation of this agreement between parties, then the Public Health -Seattle & King County Food Service Operators Permit may be suspended. DISTRICT HEALTH CENTERS ~WNTO"\)'N EASTGATE 4015 A,,-e. 11 Floor 14350 S.E. Ea...<ctgate '\Vay Seattle, WA98104 Belle1o'lte, WA9800i. 206-263-9566 :206-296-9i91 S/EIBhar~/T .e-d:i..:h!a='Food.'Food Fams.12013 foodfonns! 2013 l:se cl Rt:stroom A.grttment Av.zilable i11 alt¥mctiv~forma!upon nquotp<.JrS!KM to All! Gmail -Pizza Trailer https://mail.google.com/mail/u/O/?ui=2&ik=8339966f57&view=pt&sea ... \ f!.enton of! Pizza Trailer 1 message Kelly Carner <kelvisss@gmail.com> To: bill.haytack@mclendons.com ,-.,t':/ o c.·,\,\s100 'V '\ICU• \)\3(1\\I< . Kelly Carner <:kelvisss@gmail.com> . r,\\\ 1,Si \\ I Wed, Feb 27, 2013 at 4:35 PM Hi this is Kelly I dropped in on Tuesday we were talking about being a food vendor at your store. Here is some info about the trailer 8'x16' we cook the pizza in 90 sec we also use apple wood. and here some pictures .. a questions lease call me 206-992-5394 or email kelvisss@gmail.com ,~, -. Thank you for your time and consideration . 3/6/2013 10:52 AM . /3;-ll ~Jtk-l(' /111 l~·zz:11-rmt'l-et/ I I ks /3115, L1~Se; 'fi1 I f Q. APPLICATION FOR CITY OF RENTON BUSINESS LICENSE rs /7 FILL OUT THIS FORM COMPLETE I_,¥,\\ t\ Cc, -----1Ftimi~@@ e {INCOMPLETE APPLICATIONS WILL NOT B~~E:Pd0 . \'lj O ,;j\'i\S COMMERCIAL G' 00\"°' o\"c Business CANNOT operate until the application has been approved \ ·,\\'" ~ GENERAL BUSINESS LICENSE Required: Every business enterprise, including those with a temporary or porta~~-~ location, shall obtain, from the Fiscal Services Division, a general business license for the current calendar year.r.J:N~n9e shall be nontransferable. Reference Renton Municipal Code Titles Chapters. 'M . Have·you previo.usly had a Renton Business License? NO Is your business door-to-door solicitation/peddler? NO (if so, please stop and complete a Peddler Permlt Form) Business Telephone#: MG-qqJ..-5'. 3qq Mailing Address (Please check if same as above) D Are you a non-profit entity? 6.}d.1f so, please provide Fo m 50 c)(3) Date Business is Expected to Open in Renton: aq, I 3 Emergency Name & Telephorle Number (other than owner} 1. Tin C.&f?!vtg.( 206-7/'j-CJS(l, DESCRIBE TYPE OF BUSINESS IN DETAIL: C OtJ&;'.'Si~...vlP} ZZI+ J Owner's Telephone#: Business license Fees Estimate hours worked for 1 full year from date business is expected to open: (this includes all hours worked by owners, family, employees whether paid or unpaid) Estimated Total Hours Worked: __ L/_._,Dc...D_CJ ___ _ !.f hour-s·are over l,920 compiete-Section 1 helow:·,!f-·hours are under-,-1';920.paythe amount in Section 2 below-. · , · ·.·-·. · : .. ·. ,?\Sectionl.:< .. -....... ·.:., .. ,· · Over 1,920 hours:.· Calculate buSineSs· licerise·fee ·as· foiloWs·-~ ... •,>. -);,._ '·: · Section 2 ,. · ._·_. <-'.·. ·. -·.· _ ...... ·. · 1,920 hoUrs or "t:eSs · a. Multiply estimated hours worked -~4 ..... 0~t'J~/)~--X .034 = s {%, Minimum License Fee $65.00 (license fee) $45.00 (base feel b. Plus Base License Fee of: s 45.00 Total Business Ucense Fee Due: Add line a+ Line b: . s i-r< L .J!fl-TOTAL DUE: $110.00 I hereby swear or affirm that the statements and information furnished by me on this application are, to my knowledge, accurate, true and complete. I acknowledge that these statements and information are public records that may be available for public inspection pursuant to RCW 42-56, the Public records act, and that any inaccurate, false, or incomplete statement may be a crime under the RCW and/or RMC, punishable under RCW 9.92 and/or RMC 1-3-1. Return Completed Application with payment to: FOR OFFICE USE ONLY AMOUNT PAID Commercial 12/2012 City of Renton License Division 1055 South Grady Way Renton, WA 98057 . DATE HOW PAID Date:. __ .i..:::11--,µ.,.!J-,..6.1:ia..L_ Phone: J{'J6--qq~ -_c;·"3C(<f Phone: 425-430-6851 Fax: 425-430-6983 Email: licensing@rentonwa.gov I NAICS# I APPUCA TION # . . I I Gmail -Pizza Trailer https://mail.google.comlmail/u'O/?ui~2&ik=8339966fi7&view,it&sea ... 1 of 1 Cr~ Pizza Trailer 1 message I I Kelly earner <kelvisss@gmail.com> To: bill.haytack@mclendons.com Kelly Carner <kelvisss@gmail.com> Wed, Feb 27, 2013 at 4:35 PM Hi this is Kelly I dropped in on Tuesday we were talking about being a food vendor at your store. Here is some info about the trailer 8'x16' we cook the pizza in 90 sec we also use apple wood. and here some pictures .. any questions lease call me 206-992-5394 or email kelvisss@grnailcom I -.. Thank you for your time and consideration . 3/6/2013 10:52 AM