Community Event Application

Community Event Permit Application
FEES:

1 Vendor: $114.78

2-5 Vendors: $229.56

Each additional vendor= $30.00 (if submitted after event start date= $50.00)

Submissions less than two weeks before event start date: $459.12
Event Information
Non-Profit Organization? *
Note: 100% of proceeds from ALL vendors MUST go to the non-profit organization in order to be eligible for fee exemption. Must include Non-Profit Tax ID#.

Event Coordinator Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Day of Event Phone Number*
Please enter a valid phone number.
**The following must be included with the form at the time of submittal**:
At the event, the following is required from the Event Coordinator:
- Ensure completion of the self-inspection checklist by each vendor.
- Assist Environmental Health Department staff to resolve any health issues.
- Take primary responsibility in assisting in language translation, if applicable.
As coordinator, I certify that I have read the attached information and am familiar with the laws pertaining to food/drink service at a community event as stated in the California Retail Food Code and agree to operate the event in a manner consistent with those laws.

First Name* Last Name* Signature* Date*

Food Vendor List & Event Site Plan

FA# and PR# are provided by the Environmental Health Department and can be located on vendor's permit.
Name of Event:
Please select number of Vendors
Vendor 1
Vendor 2
Vendor 3
Vendor 4
Vendor 5
Vendor 6
Vendor 7
Vendor 8
Vendor 9
Vendor 10
Vendor 11
Vendor 12
Vendor 13
Vendor 14
Vendor 15
Vendor 16
Vendor 17
Vendor 18
Vendor 19
Vendor 20

Please upload your Site Plan here:
File Upload

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Environmental Health Department

950 Maidu Avenue Suite #170 PO BOX #599002 Nevada City, CA 95959
AGREEMENT TO PAY
Nevada County Community Development Agency fees are based on Board of Supervisor approved fee schedules. Hourly fees and fees for services in excess of a minimum fee collected, including reinspections, are billed to the applicant based on the Board approved fee schedule in effect at the time the work is performed by staff. This Agreement To Pay form must be signed and original signatures submitted to the NCCDA along with the completed permit forms and the initial payment of fees. Copies of current fee schedules are available from our Customer Service Staff or on the web at http://www.nevadacountyca.gov

I/We understand that the NCCDA will bill as services are rendered, and I/We agree to pay such billing within thirty (30) days of the mailing of such billing for the project/permit. If payments on outstanding invoices are not made within thirty (30)days after the date of the invoice, County staff may cease work on the project until the required payment is made,subject to any other provisions of the law. All fees must be paid prior to the granting of any permits, approvals, or anyland use entitlement for which services are required. The collection of fees, however, does not guarantee the granting ofany permits, approvals, or land use entitlements for which I/We are applying.
Site Information:*
Invoices and/or notices to be mailed to:*
NCCDA Staff is authorized to consult with necessary governmental agencies and the following individuals concerning this project: Name Here*
I certify under proof of perjury that I am the property owner or that I am authorized to enter into this fee agreement on his/her behalf. I have read the conditions concerning Nevada County Community Development Agency Fees and I understand that in the event that the billing party I have indicated does not pay required fees, I will be responsible for payment. I further agree to advise the department in writing should I no longer be associated with the above referenced project/property, rendering this agreement invalid as of the change of the date that the letter is received by the Nevada County Community Development Agency.

Signature: * Printed Name:* Date*
THIS SECTION FOR OFFICE USE ONLY
Should be Empty:

Community Event Permit Application

Event Information

Event Coordinator Information

Food Vendor List & Event Site Plan

Please upload your Site Plan here:

Environmental Health Department

AGREEMENT TO PAY

THIS SECTION FOR OFFICE USE ONLY