577 Hannan St, Kalgoorlie
Telephone: (08) 9021 9600
PO Box 2042, Boulder WA 6432
Facsimile: (08) 9021 6113
NOTIFICATION OF A FOOD STALL or TEMPORARY FOOD PREMISES
To:
Chief Executive Officer
City of Kalgoorlie-Boulder
A one-off processing fee of $65 applies.
NB: Community associations are exempt
I/We
(full name in block letters)
of
(full residential / business address)
Hereby notify the City of Kalgoorlie-Boulder of the Food Stall / Temporary Food
Premises described* as
* or trading as (business name)
List of food(s) provided or sold:
Will the food be prepared at a different location from where it is sold <HV No
If Yes where
Date/s of Proposed Event:
Proposed Trading Hours:
Location of the Stall:
Name of Proprietor:
Phone Number:
Mobile Number:
Email Address:
A Site plan showing stall(s) location is to be attached to the application
(Signature of Applicant/s)
(Date)
Note: “Community Association” means an institution, association, club, society or body, whether
incorporated or not, the objects of which are of a charitable, benevolent, religious, cultural, educational,
recreational, sporting or other like nature and the members of which are not entitled or permitted to receive
any pecuniary profit from the transactions thereof.
Office use only
Checked by officer:
Food Premises Registration Fee
ACCOUNT: 22010183
Submit form
Fee: $65.00