@php
    $lang = 'en';
@endphp
<form id="permitApplicationForm" method="POST" enctype="multipart/form-data"
    action="{{ route('submitHotelMotelPermitApplication') }}">
    <input type="hidden" name="application_type" id="application_type" value="online">
    <input type="hidden" name="initial_applications" id="initial_applications" value="{{ $initialApplication->id }}">

    <div class="card-header" style="background-color: #022E5F;">
        <h5 style="color:white">
           Hotel/Motel Permit Application <span class="text-warning"></span>
        </h5>
    </div>
    <div class="card card-outline" style="border-top: 3px solid #022e5f;">
        <div class="card-header">
            <h5 style="color: #022e5f;">Hotel/Motel Information </h5>
        </div>
        <div class="card-body">
            <div class="row">
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Hotel/Motel Name<span
                            class="text-danger">&#42;</span></label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required" id="event"
                        name="event" placeholder="Hotel/Motel Name" />
                    <span id="event_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Address <span
                            class="text-danger">&#42;</span></label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required"
                        id="location_of_event" name="location_of_event" placeholder="Address " />
                    <span id="location_of_event_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Email </label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required" id="vendor_email"
                        name="vendor_email" placeholder="Email" />
                    <span id="vendor_email_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Motel/Hotel Phone </label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required phone"
                        id="cell_phone" name="cell_phone" placeholder="Motel/Hotel Phone " />
                    <span id="cell_phone_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">FAX </label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required phone"
                        id="vendor_cell_phone" name="vendor_cell_phone" placeholder="FAX" />
                    <span id="vendor_cell_phone_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Number of Rooms </label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required" id="event_organizer"
                        name="event_organizer" placeholder="Number of Rooms" />
                    <span id="event_organizer_error" class="error text-danger"></span>
                </div>


                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Application Date </label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required dateField"
                        id="date_of_event" name="date_of_event" value="{{ date('m/d/Y') }}" placeholder="Date Of Event"
                        style="background-color: #fff;" readonly />
                    <span id="date_of_event_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Exp Date </label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required dateField"
                        id="date_of_event" name="date_of_event" value="{{ date('m/d/Y') }}" placeholder="Date Of Event"
                        style="background-color: #fff;" readonly />
                    <span id="date_of_event_error" class="error text-danger"></span>
                </div>
            </div>
        </div>
    </div>
    <div class="card card-outline" style="border-top: 3px solid #022e5f;">
        <div class="card-header">
            <h5 style="color: #022e5f;">Owner/Applicants Information </h5>
        </div>
        <div class="card-body">
            <div class="row">
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Name<span
                            class="text-danger">&#42;</span></label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required" id="event"
                        name="event" placeholder="Name" />
                    <span id="event_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Mailing Adress <span
                            class="text-danger">&#42;</span></label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required"
                        id="location_of_event" name="location_of_event" placeholder="Mailing Adress " />
                    <span id="location_of_event_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Email </label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required" id="vendor_email"
                        name="vendor_email" placeholder="Email" />
                    <span id="vendor_email_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Phone</label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required phone"
                        id="cell_phone" name="cell_phone" placeholder="Motel/Hotel Phone " />
                    <span id="cell_phone_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">FAX </label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required phone"
                        id="vendor_cell_phone" name="vendor_cell_phone" placeholder="FAX" />
                    <span id="vendor_cell_phone_error" class="error text-danger"></span>
                </div>

            </div>

        </div>
    </div>
    <div class="card card-outline" style="border-top: 3px solid #022e5f;">
        <div class="card-header">
            <h5 style="color: #022e5f;">Onsite Operators Information</h5>
        </div>
        <div class="card-body">
            <div class="row">
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Name<span
                            class="text-danger">&#42;</span></label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required" id="event"
                        name="event" placeholder="Name" />
                    <span id="event_error" class="error text-danger"></span>
                </div>

                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Email </label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required" id="vendor_email"
                        name="vendor_email" placeholder="Email" />
                    <span id="vendor_email_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Phone</label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required phone"
                        id="cell_phone" name="cell_phone" placeholder="Motel/Hotel Phone " />
                    <span id="cell_phone_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">FAX </label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required phone"
                        id="vendor_cell_phone" name="vendor_cell_phone" placeholder="FAX" />
                    <span id="vendor_cell_phone_error" class="error text-danger"></span>
                </div>

            </div>

        </div>
    </div>
    <div class="card-header">
        <h5 style="color: #022e5f;">
            Please upload the following documents as a .pdf, .png, or a .jpg. Max size per file 10mb.
        </h5>
    </div>
    <div class="card-body">
        <div class="row">
            <div class="col-md-6">
                <div class="row">
                    <div class="col-12">
                        <div class="row border card" style="width: 80%;">
                            <div class="card-header" style="font-size: 16px; font-weight: bold; color: blue;">
                                Document upload (Images upload ----Upload Menu, Layout, Application
                                Packet.)
                            </div>
                            <div class="card-body">
                                <div class="row">
                                    <div class="col-md-6">
                                        <input class="form-control" type="file" id="document_upload_1"
                                            name="document_upload_1"
                                            accept="image/jpeg, image/jpg, image/png, application/pdf" />
                                    </div>
                                    <div class="col-md-6">
                                        <input class="form-control" type="text" id="document_name_1"
                                            name="document_name_1" placeholder="Document Name" />
                                    </div>
                                </div>
                                <br />
                                <div class="row">
                                    <div class="col-md-6">
                                        <input class="form-control" type="file" id="document_upload_2"
                                            name="document_upload_2"
                                            accept="image/jpeg, image/jpg, image/png, application/pdf" />
                                    </div>
                                    <div class="col-md-6">
                                        <input class="form-control" type="text" id="document_name_2"
                                            name="document_name_2" placeholder="Document Name" />
                                    </div>
                                </div>
                                <br />
                                <div class="row">
                                    <div class="col-md-6">
                                        <input class="form-control" type="file" id="document_upload_3"
                                            name="document_upload_3"
                                            accept="image/jpeg, image/jpg, image/png, application/pdf" />
                                    </div>
                                    <div class="col-md-6">
                                        <input class="form-control" type="text" id="document_name_3"
                                            name="document_name_3" placeholder="Document Name" />
                                    </div>
                                </div>
                                <br />
                                <div class="row">
                                    <div class="col-md-6">
                                        <input class="form-control" type="file" id="document_upload_4"
                                            name="document_upload_4"
                                            accept="image/jpeg, image/jpg, image/png, application/pdf" />
                                    </div>
                                    <div class="col-md-6">
                                        <input class="form-control" type="text" id="document_name_4"
                                            name="document_name_4" placeholder="Document Name" />
                                    </div>
                                </div>
                                <br />
                                <div class="row">
                                    <div class="col-md-6">
                                        <input class="form-control" type="file" id="document_upload_5"
                                            name="document_upload_5"
                                            accept="image/jpeg, image/jpg, image/png, application/pdf" />
                                    </div>
                                    <div class="col-md-6">
                                        <input class="form-control" type="text" id="document_name_5"
                                            name="document_name_5" placeholder="Document Name" />
                                    </div>
                                </div>
                                <br />
                            </div>
                        </div>
                    </div>
                </div>
            </div>
            <div class="col-md-6">
                <div class="row">
                    <div class="col-12">
                        <div class="card card-primary">
                            <div class="card-body" id="applicantSignature">
                                <div class="row">
                                    <input type="hidden" name="applicantSignatureBase64"
                                        id="applicantSignatureBase64" value="" />
                                    <div class="col-md-12 col-sm-12">
                                        <h6 class="control-label">
                                            <label class="control-label text-secondary">
                                                Applicant’s Signature:
                                            </label>
                                            <span class="pull-right">
                                                <button type="button" data-action="clear"
                                                    class="btn btn-xs btn-danger">
                                                    <i class="fa fa-trash"></i>
                                                    Clear
                                                </button>
                                            </span>
                                        </h6>
                                        <div class="m-signature-pad border">
                                            <div>
                                                <canvas width="750" height="130"></canvas>
                                            </div>
                                            <input type="text" name="applicant_signature_date"
                                                id="applicant_signature_date"
                                                class="form-control form-control-sm form-control form-control-sm-sm mt-3 dateField"
                                                placeholder="Select Date"
                                                style="color: black;
                                                                   font-weight: bold;" />
                                            <span id="applicant_signature_date_error"
                                                class="error text-danger"></span>
                                        </div>
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>

                </div>
            </div>
        </div>
    </div>

</form>