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Annual Food Permit Payment Form (no late fees)

  1. SJCHD logoCMYK

  2. Annual Food Permit Payment Form

    Please complete this form after you have submitted your renewal application through DocuSign.

  3. You must list all the business addresses for all the permits you are paying for at this time. For example, if you have 3 locations, you can fill out 3 applications through DocuSign, and then use this one payment form to pay for all three applications. Just list all three business location addresses.

  4. Gross Sales between $0.00 and $49,999.99

    $75 Annual Permit

  5. Price

  6. Gross Sales between $50,000.00 and $149,999.99

    $100 Annual Permit

  7. Price

  8. Gross Sales between $150,000.00 and $249,999.99

    $125 Annual Permit

  9. Price

  10. Gross Sales between $250,000.00 and $499,999.99

    $150 Annual Permit

  11. Price

  12. Gross Sales between $500,000.00 and $749.999.99

    $200 Annual Permit

  13. Price

  14. Gross Sales between $750,000.00 and $999,999.99

    $250 Annual Permit

  15. Price

  16. Gross Sales between $1,000,000.00 and $1,249,999.99

    $300 Annual Permit

  17. Price

  18. Gross Sales between $1,250,000.00 and $1,499,999.00

    $325 Annual Permit

  19. Price

  20. Gross Sales over $1,500,000.00

    $375 Annual Permit

  21. Price

  22. Initial Administrative Fee

    if applicable

  23. Price

  24. Online Payment Fees:

    Online payments are processed by Forte. A fee of 2.5% or $1.50 (whichever is greater) will be assessed for all credit card payments. Electronic Checks are also accepted, and will be assessed a flat $1.25 for any payment under $50,000. The appropriate fee will be added to the total cost of your payment.

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