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Vending Machine Permit Application (Web Form)
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This form has been modified since it was saved. Please review all fields before submitting.
Steps
1.
Page 1 - Instructions for Submission
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This section is incomplete
2.
Page 2 - Contact Information
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This section is incomplete
3.
Page 3 - Permit Questionnaire
This section is complete
This section is incomplete
4.
Page 5 - Review Notice
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This section is incomplete
5.
Page 6 - Review Disclosures
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6.
Page 7 - Review and Sign
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Page 1 - Instructions for Submission
Vending Machine Application
Maricopa County Environmental Services Department
Environmental Health Division
Permitting Services Program
Phone: (602) 506-6824
esplanreview@maricopa.gov
Follow all instructions below to avoid delays in the application review process.
Application Steps
1. Fill out and submit your application .
2. Our office will review the application and coordinate an onsite inspection.
3. Once qualified for a permit, pay permit fees (online, in person, over the phone, fax, or by mail).
Checklist for review
Complete Application (please indicate n/a, if not applicable rather than leaving empty boxes on the application)
Proposed Menu(s)
Current Letter of Certification from NAMA (National Automatic Merchandizing Association)
Cut Sheets/schematics of all equipment to be installed; including any custom built equipment
Water sampling results (water and ice machines); must be provided prior to approval and at renewal each year
List of all locations where machines will be set-up, along with details on type of machine (i.e. water, ice, frozen, fresh, coffee, etc.)
Fee Schedule:
Fee Schedule
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Page 2 - Contact Information
Business Information (Name on Establishment)
Business Name
*
Address
*
City
*
State
*
Zip
*
Phone
*
Business Owner Information (Responsible Party)
Entity Type
*
Sole Proprietorship (Must show lawful presence)
Corporation
Association
Other
If Other, please describe:
Owner/Corporation
*
Address
*
City
*
State
*
Zip Code
*
Phone Number
*
Fax Number
Email Address
Mailing/Billing Information
If same as above, please check box.
Owner Name
Address
City
State
Zip Code
Phone
Fax
Email Address
Inspection or Plan Review Response Contact
If same as above, please check box.
Inspection Contact Name
Address
City
State
Zip Code
Phone
Email Address
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Page 3 - Permit Questionnaire
How many vending machines are owned by this business?
List of all locations where machines will be set up as well as the type of machine (e.g. packaged food, water, coffee, etc.)
Please provide location as well as type of machine. Please upload to the cloud drive (instructions below) if file size exceeds 20MB.
Proposed menu/items provided in machines
Please provide menu(s). Please upload to the cloud drive (instructions below) if file size exceeds 20MB.
Letter(s) of certification from NAMA (National Automatic Merchandizing Association)
Please provide current letters for all the variations of machines. Please upload to the cloud drive (instructions below) if file size exceeds 20MB.
Equipment cut sheets/schematics
Please provide equipment cut sheets for all vending machines. Please upload to the cloud drive (instructions below) if file size exceeds 20MB.
Water Sampling Results
If you are providing water vending machines, please provide water sampling results annually for all water and ice vending machines. Please upload to the cloud drive (instructions below) if file size exceeds 20MB.
Electronic Delivery of Plans/Plumbing & Finish Schedule
I will deliver hard copy.
Deliver hard copy to the Department if not able to attach here or in the cloud drive (instructions provided below). Please provide the layout and plumbing/finish schedule for all projects involving construction/review. Please be advised that the documents must be legible to avoid delays in the review process.
Plan Review Cloud Drive
Link to the cloud
Please use this link to upload files for plan review (layout).
Instructions for uploading files to the cloud:
Instructions
Please ensure you follow instructions to ensure application is processed and reviewed without delay.
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Page 5 - Review Notice
ARS § 11-1604. Prohibited acts by county and employees; enforcement; notice
A county shall not base a licensing decision on whole or in part on a licensing requirement or condition that is not specifically authorized by statute, rule, ordinance or delegation agreement. A general grant of authority does not constitute a basis for imposing a licensing requirement or condition unless the authority specifically authorizes the requirement or condition.
Unless specifically authorized, a county shall avoid duplication of other laws that do not enhance regulatory clarity and shall avoid dual permitting to the maximum extent practicable.
This section does not prohibit county flexibility to issue licenses or adopt ordinances or codes.
A county shall not request or initiate discussions with a person about waiving that person's rights.
THIS SECTION MAY BE ENFORCED IN A PRIVATE CIVIL ACTION AND RELIEF MAY BE AWARDED AGAINST A COUNTY. THE COURT MAY AWARD REASONABLE ATTORNEY FEES, DAMAGES AND ALL FEES ASSOCIATED WITH THE LICENSE APPLICATION TO A PARTY THAT PREVAILS IN AN ACTION AGAINST A COUNTY FOR A VIOLATION OF THIS SECTION.
A COUNTY EMPLOYEE MAY NOT INTENTIONALLY OR KNOWINGLY VIOLATE THIS SECTION. A VIOLATION OF THIS SECTION IS CAUSE FOR DISCIPINARY ACTION OR DISMISSAL PURSUANT TO THE COUNTY'S ADOPTED PERSONNEL POLICY.
THIS SECTION DOES NOT ABROGATE THE IMMUNITY PROVIDED BY SECTION 12-820.1 OR 12-820.02.
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Page 6 - Review Disclosures
A “grandfather” clause or provision is not provided for in Maricopa County Environmental Health Code. All establishments under new ownership, newly built, or remodeled shall meet current construction, equipment, facility, and operational regulations as adopted and provided for in the Maricopa County Environmental Health Code, guidelines, and procedures, and policy statements. A permit shall not be issued to a facility for which a permit is required, and shall not be allowed to operate until the applicant demonstrates to the Department full compliance with applicable provisions of the Maricopa County Environmental Health Code. Any construction, alteration, or addition shall be made in accordance with specifications approved by the Department. The owner, operator, or authorized agent shall certify in writing that the establishment will comply with these regulations. On-site inspections of the facilities and premises with equipment in place and operating will be necessary to determine compliance with the Maricopa County Environmental Health Code.
Delivery of Inspection Reports
Pursuant to A.R.S. § 41-1009, the Department may enter your establishment to conduct inspections. You have the right to receive a copy of the Department's inspection report at the time of the inspection, within thirty (30) days after the inspection, or as otherwise provided by federal law. I agree that the Department may send me a copy of its inspection report by e-mail or by facsimile transmission to the e-mail or fax number provided under the Business Ownership Information provided above. It is the responsibility of the permit holder to update the Department if there is a change in contact information.
Disclosure Acknowledgement
*
I have reviewed the notice and disclosures.
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Page 7 - Review and Sign
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.
Application Acknowledgement
*
I agree the application is true and correct.
Arizona law, A.R.S. § 11-1605(I), allows Maricopa County Environmental Services Department (MCESD) and the applicant for a license to mutually agree to extend the plan review time frame by 50 percent of the substantive time frame and overall time frame. MCESD will agree to any applicant's request for an 50 percent extension of the substantive review time frame and overall time frame when box is checked and signed below.
Licensing Time Frame Extension Acknowledgement
I agree to the 50 percent extension.
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.
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:
Receive an email copy of this form.
Email address
This field is not part of the form submission.
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