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<br />," <br /> <br />,/ <br /> <br />Food Permit Application <br />Chapter 500. F.S. <br /> <br />In accordance with Chapter 500, F.S. The Department of Agriculture and Consumer Services is the exclusive regulatory and permitting authority <br />for any person, business or corporation engaged in manufacturing, processing, packing, holding, or preparing food or selling food at v.tIolesale <br />or retail. For purposes of this application, food is considered to include, but is not limited to, all prepac/(aged grocery items, prepared foods, <br />packaged ice, bottled or vended water, candy and other snack foods, soda, infant formula, vitamin and mineral dietary supplements. <br /> <br /> <br />Florida Department of Agriculture and Consumer Services <br />BOB CRAWFORD, Commissioner Bureau of Food and Meat Inspection <br />Division of Food.Safety 3125 Conner Boulevard <br />. Tallahassee, Fl32399-1650 <br />(850)488-3951 <br /> <br />Firm # 9495276876782 INFORMATION ABOUT THE LOCATION TO BE PERMITTED Territory # 450 <br />Rrm Permit Type/Description 164/MOBILE VEHICLE <br />( ) Renewal ()( New Business ( ) Change of Owner ( ) Other: <br />Name of Business County <br />STEVE'S SNOBALLS PASa7 <br />Business Location Address Business Location Town Zip <br />4()251 SUNBURST DRIVE DADE CITY 33525 <br />Do you manufacture and package ice or bottle water for sale? ( ) Yes <X) No. If Yes: the following information must be submitted with <br />the application: 1. Indicate source(s) of water used. 2. Indicate any treatment provided to the ice prior to packaging. <br /> INFORMATION ABOUT THE OWNER <br />Check one ('>( Sole Proprietor ( ) Partnership ( ) Corporation ( ) Other: <br />Legal Name of Owner Phone # Ext. <br />STEPHEN W NORWOOD (352)567-3176 <br />Business Mailing Address <br />4()251 SUNBURST DRIVE <br />Business City Business State Zip <br />DADE CITY FL 33525 <br />Federal Employers Identification (FEIN) Number or Sales Tax # <br />Owner's Social Security Number <br /> 212-40-8083 <br />This application must be signed by the applicant, owner or chief executive of the applicant, without the need for witnesses. If a corporation is <br />in the hands of a receiver or trustee, this application shall be executed on behalf of the corporation by the receiver or trustee. I certify that I <br />am empowered to execute this application as required by Chapter 500 F.S. <br /> Print Name of Applicant Ii\\. vII' LU OOc..~ TiDe <br /> \:""l t- ()1 Pt~;Nt~ <br /> ,~ e. r :\. e. ''\. W. <br /> Si~re ." . (', Date <br /> \ . j 7- I :3 - c~) I <br /> .<S jo .~t_____ LU ,rU iY~V7..--~~ <br />DACS-1403-06 (1~3) Rev. 10/96 <br />