APPLICATION FOR A TRANSITIONAL PERMIT

For A Food Service Establishment

***Zoning approval may be required prior to submitting this application.

Plan Review with a $250 fee may be required for any new construction, remodeling or additions.

No Charge for actual transitional permits to operate.

Name of Establishment:
Establishment Address:
City:	State:	NC	Zip:
Telephone Number:	Email:
Owner/Corporate Name:
Manager/Person-in-Charge:
Mailing Address:
City:	State:	Zip:
Telephone Number:	Email:
Owner of Building:
Mailing Address:
City:	State:	Zip:
Telephone Number:	Email:
Type of food service establishment: (select/complete all that apply)
Restaurant with seating: Number of seats:	Square footage:
Food Stand: Square footage:	(No more than 8 seats, Ref. Session Law 2015-104)
Commissary	Sit-down Meals
Meat Market	Take-out Meals
Education Food Service	Catering/ Delivery
School Lunchroom	Customer Self-Service Buffet/Bar
Elderly Nutrition Site, Prepared On-site
Other: (ex: hot bar, sushi bar, salad bar)
Water Supply and Sewage: Water supply: Public/Municipal Private Water Supply Sewer: Public/Municipal On-site Wastewater System

General:

Will the establishment be removing any of the existing equipment? Yes No

Will the establishment be adding new equipment? Yes No

If so, then provide specification sheets for all new equipment to be installed.

Will the establishment maintain the same menu as the previous owner? Yes No

Provide a copy of the existing or proposed menu with this application.

Will the establishment be conducting any new construction, remodeling, or additions? Yes No

If yes, then plan review with a $250 fee may be required.

A pre-opening inspection of the establishment with equipment will be necessary to determine compliance with the local and state laws governing food establishments. You will be responsible for obtaining approval from appropriate zoning and building inspection departments. Their numbers are included below to assist you.

ZONING / BUILDING INSPECTION	FIRE MARSHALLS

Shelby 704-484-6805	704-484-6816

Kings Mountain 704-734-4599	704-734-0555

Cleveland County 980-484-4975/4997	704-481-4841

If your business will be located in any jurisdiction other than those listed above, please check with your city manager and/or town hall for permitting assistance.

Proposed opening date:
Date Application Submitted:
Applicant’s Signature:

APPLICATIONS CAN BE SUBMITTED IN PERSON OR BY MAIL TO:

Cleveland County Permits Office

1333 Fallston Road

Shelby, NC 28150

Rev. 12/23