The application must include:

(1) The name, birth date or Unified Business Identifier, mailing address, telephone number, and signature of the person applying for the permit and the name, mailing address, and location of the food establishment;

(2) Information specifying whether the food establishment is owned by an association, corporation, individual, partnership, or other legal entity;

(3) A statement specifying whether the food establishment:

(a) Is mobile or stationary and temporary or permanent; and

(b) Is an operation that includes one or more of the following:

(i) Prepares, offers for sale, or serves time/temperature control for safety food:

(A) Only to order upon a consumer's request;

(B) In advance quantities based on projected consumer demand and discards food that is not sold or served at an approved frequency; or

(C) Using time as a public health control under WAC 246-215-03530;

(ii) Prepares time/temperature control for safety food in advance using a food preparation method that involves two or more steps which may include combining time/temperature control for safety food ingredients; cooking; cooling; reheating; hot or cold holding; freezing; or thawing;

(iii) Prepares food as specified under (b)(ii) of this subsection for delivery to and consumption at a location off the premises of the food establishment where it is prepared;

(iv) Prepares food as specified under (b)(ii) of this subsection for service to a highly susceptible population;

(v) Prepares only food that is not time/temperature control for safety food; or

(vi) Does not prepare, but offers for sale only prepackaged food that is not time/temperature control for safety food.

(4) The name, title, address, and telephone number of the person directly responsible for the food establishment;

(5) The name, title, address, and telephone number of the person who functions as the immediate supervisor of the person specified under subsection (4) of this section such as the zone, district, or regional supervisor;

(6) The names, titles, and addresses of:

(a) The persons comprising the legal ownership as specified under subsection (2) of this section including the owners and officers; and

(b) The local resident agent if one is required based on the type of legal ownership.

(7) A statement signed by the applicant that:

(a) Attests to the accuracy of the information provided in the application; and

(b) Affirms that the applicant will:

(i) Comply with this chapter; and

(ii) Allow the regulatory authority access to the establishment as specified under WAC 246-215-08415 and to the records specified under WAC 246-215-03290, 246-215-05280 and 246-215-08215 (4)(f); and

(8) Other information required by the regulatory authority.