Mobile Food Vehicle Permit

Woodburn Fire District Fire Prevention

1776 Newberg Highway, Woodburn, OR 97071

Mobile Food Vehicle Fire Safety Operational Permit Application

Business Name

Business Address

Date

City, State, Zip

Owner

DL#

State

Owner Address

City, State, Zip

Telephone #

Cell Phone #

Mobile Unit License Plate #

Month/Year

Marion County Environmental Health Permit/Classification

Date

Service Location/s (Need Map Attached)

Mobile Unit Fire Protection Information

Fire Extinguisher/s Mfg., Type, Size, Location/s

Last Inspection Dates

Fire Suppression System Type

Original Reviewed/Approved Date

Last Inspection/Test Date

Any Changes, modifications to Mobile Unit requiring new inspection or additional fire protection systems installed

Permit Application Instructions

This permit application can be filled out prior to or during a vehicle inspection, however, any violations of vehicle inspection must be resolved prior to issuing a permit to operate. This includes the permit and licensing through the Marion County Environmental Health “Food Licensing Program.” Plans of vehicle design and installation must be provided for review and all information about the vehicle on page one and all additional pages must be complete. Fill out the following:

Number of Propane Tanks, Sizes and Location:

Detail of appliances/equipment utilizing propane:

Detail of appliances/equipment utilizing electrical:

Details of Generator, make/model, fuel tank size, location, etc.:

Details of Ventilation System, make/model, cfm output, etc.:

Make/Model, Vin# of Mobile Unit:

Fee Payment: Please enclose a check/money order for $50 payable to Woodburn Fire District for the issuance of a Mobile Unit fire safety operational permit.

Print and sign name below. By signing and submitting this application packet, you confirm that all information is valid, complete, and correct.

Applicant Name (print):

Signature

Date

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