Form HR 5021-103 at a glance
What it is: SEATING CHANGE EVALUATION: completion of this form ensures that public food service establishments are evaluated for adequate sewage and fire services before expanding seating operations.
Where and when to file: Submit the completed form to the local Division of Hotels and Restaurants district office.
A filled-in Form HR 5021-103 example: a restaurant adds seats
How to fill out Form HR 5021-103, box by box
Section 1 - Establishment information
In Section 1, Establishment Information, enter the Establishment Name, License Number, Current No. Seats and Proposed No. Seats.
Enter the Address of Establishment, City, County and Zip, then the Contact Person Name / Phone No. and the Contact Person E-Mail Address.
Section 2 - Wastewater system
Section 2, Wastewater System, is to be completed by DOH, DEP or Utility Authority: the above named food service establishment uses the following wastewater disposal system (choose one type):
Municipal / Utility Name of Provider, Package Plant Name of Provider or Septic Tank.
Section 3 - Fire safety
Section 3, Fire Safety, is to be completed by Local Authority Having Jurisdiction: the above named food service establishment proposes to increase the seating capacity, with Number of Exits (Public, Employee, Total) and the Fire Safety Evaluation Result, Approved or Denied (see comments).
H&R Change Record Form Attached
H&R Change Record Form Attached.
Common questions about Form HR 5021-103
Where do I file it?
Submit the completed form to the local Division of Hotels and Restaurants district office.
Sources
[1] Form HR 5021-103 (2018 June), Seating Change Evaluation, State of Florida Department of Business and Professional Regulation, Division of Hotels and Restaurants (the Official source link on this page).
