City of Edina Form Center

2. Note:
   Fees are based on food establishment’s license type. Fees will be determined by Health Division staff and included in initial review letter.
4. Establishment Name*
6. Establishment Address*
8. Owner Information
10. Owner Name*
11. Owner Email Address*
13. Owner Address*
15. City*
16. State*
17. Zip Code*
19. Owner Phone Number*
21. Primary Contact for Plan Review Approval Process:
23. Name*
24. Email Address*
26. Primary Contact Address*
28. City
29. State
30. Zip Code
32. Phone Number*
34. Primary Contact on Job Site (if different than above):
36. Name
37. Email Address*
39. Address
41. City
42. State
43. Zip Code
45. Phone Number*
47. Submit for Review:
49. Complete menu, including plans for any future additions or unique food processes.*
50. Hours of Operation*
52. One complete set of plans with numbered equipment.*
53. Number of seats in establishment*
55. Numbered specification sheets of all equipment, including manufacturer, model number, and listings.*
56. Approximate number of meals per day*
58. Floor plans for each type of lodging room (to scale).*
59. Locations and floor plans for ice machines, laundry facilities, and supply storage areas.*
61. Dry Storage Space
63. Number of Meals Per Day
64. Number of Days of Storage
65. Shelving Floor Area Needed, assuming shelving sets are three-tiered (square feet)
    (0.5 x Number of Meals Per Day) x Number of Days of Storage = Shelving Floor Area Needed
66. Floor Area Provided on Plan, assuming shelving sets are three-tiered
70. Additional information about requirements for construction or remodeling a food service facility can be found online at the links listed below:
72. Additional Requirements
    Additional Lodging Establishment Requirements
74. Health Department
    Minnesota Department of Health website
76. City of Edina
    City of Edina website
78. THE MINNESOTA DATA PRACTICES ACT requires that we inform you of your rights about the private data we are requesting on this form. Private data is available to you, but not to the public. Your e-mail address is private information. We are requesting this data to register a bee apiary on your property. You are not legally required to provide the data; however, refusing to supply the data may cause your registration to not be processed. In addition, this data can be shared by Edina City Staff. Your signature on this application indicates you understand these rights. Your residence address and telephone number will be considered public data unless you request this information to be private and provide an alternative address and telephone number. Please choose accept below to indicate that you have read this notice:*

    1. I agree.
80. Alternate Address
81. Alternate Phone
Leave This Blank:


83. 1. Receive an email copy of this form.
84. Email address

    This field is not part of the form submission.

85. Submit

* indicates a required field