@php
    $lang = 'en';
@endphp
<form id="permitApplicationForm" method="POST" enctype="multipart/form-data"
    action="{{ route('submitTempFoodPermitApplication') }}">
    <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">
            Temporary Food 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;">Basic Details</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">Event<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="Event" />
                    <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">Location of Event<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="Location of Event" />
                    <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">Date Of Event<span
                            class="text-danger">&#42;</span></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">Times<span
                            class="text-danger">&#42;</span></label>
                    <input type="time" class="form-control form-control-sm shadow mb-2 required" id="time"
                        name="time" placeholder="Times" />
                    <span id="time_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Event Organizer<span
                            class="text-danger">&#42;</span></label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required" id="event_organizer"
                        name="event_organizer" placeholder="Event Organizer" />
                    <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">Cell phone<span
                            class="text-danger">&#42;</span></label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required" id="cell_phone"
                        name="cell_phone" placeholder="Cell 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">Event Organizer Email<span
                            class="text-danger">&#42;</span></label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required"
                        id="event_organizer_email" name="event_organizer_email" placeholder="Event Organizer Email" />
                    <span id="event_organizer_email_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Name of Food Booth<span
                            class="text-danger">&#42;</span></label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required" id="food_booth_name"
                        name="food_booth_name" placeholder="Name of Food Booth" />
                    <span id="food_booth_name_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Vendor Contact<span
                            class="text-danger">&#42;</span></label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required"
                        id="vendor_contact" name="vendor_contact" placeholder="Vendor Contact" />
                    <span id="vendor_contact_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Vendor Cell Phone<span
                            class="text-danger">&#42;</span></label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required"
                        id="vendor_cell_phone" name="vendor_cell_phone" placeholder="Vendor Cell Phone" />
                    <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">Vendor Email<span
                            class="text-danger">&#42;</span></label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required" id="vendor_email"
                        name="vendor_email" placeholder="Vendor Email" />
                    <span id="vendor_email_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">
            <p style="color: #022e5f;">Please answer completely. A detailed application assists with
                the review process.</p>
        </div>
        <div class="card-body">
            <div class="row">
                <div class="col-sm-12 form-group">
                    <label class="col-form-label text-sm text-secondary">List all foods and beverages
                        that will be served at the event. (including condiments)<span
                            class="text-danger">&#42;</span></label>
                    <textarea type="text" id="list_all_foods_beverages" name="list_all_foods_beverages"
                        class="form-control form-control-sm shadow mb-2 required" placeholder="List all foods and beverages"></textarea>
                    <span id="list_all_foods_beverages_error" class="error text-danger"></span>
                </div>

                <div class="col-sm-12 form-group">
                    <label class="col-form-label text-sm text-secondary">When and where will food be
                        purchased?<span class="text-danger">&#42;</span></label>
                    <textarea type="text" id="When_and_where_will_food_be_purchased" name="When_and_where_will_food_be_purchased"
                        class="form-control form-control-sm shadow mb-2 required" placeholder="When and where will food be purchased?"></textarea>
                    <span id="When_and_where_will_food_be_purchased_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-12 form-group">
                    <label class="col-form-label text-sm text-secondary">What time will the food be
                        delivered and how will it be transported?<span class="text-danger">&#42;</span></label>
                    <textarea type="text" class="form-control form-control-sm shadow mb-2 required" id="food_be_delivered"
                        name="food_be_delivered" placeholder="What time will the food be delivered and how will it be transported?"></textarea>
                    <span id="food_be_delivered_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">How will food be kept cold?
                        (below 41F.)<span class="text-danger">&#42;</span></label>

                    <select id="food_be_kept_cold" name="food_be_kept_cold"
                        class="form-control form-control-sm shadow mb-2" onchange="cold(this);">
                        <option value="">---Select---</option>
                        <option value="during_transportation">During transportation</option>
                        <option value="at_the_event_site">At the event site</option>
                    </select>
                </div>

                <div class="col-sm-9 form-group mt-4 during_transportation hideOnLoad">
                    <textarea type="text" class="form-control form-control-sm shadow mb-2 required mt-2"
                        id="during_transportation_cold" name="during_transportation_cold" placeholder="During transportation"></textarea>
                    <span id="during_transportation_cold_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-9 form-group mt-4 at_the_event_site hideOnLoad">
                    <textarea type="text" class="form-control form-control-sm shadow mb-2 required mt-2" id="at_the_event_site_cold"
                        name="at_the_event_site_cold" placeholder="At the event site"></textarea>
                    <span id="at_the_event_site_cold_error" class="error text-danger"></span>
                </div>
            </div>
            <div class="row">
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">How will food be kept hot?
                        (above 135F.)<span class="text-danger">&#42;</span></label>
                    <select id="food_be_kept_hot" name="food_be_kept_hot"
                        class="form-control form-control-sm shadow mb-2" onchange="hot(this);">
                        <option value="">---Select---</option>
                        <option value="during_transportation">During transportation</option>
                        <option value="at_the_event_site">At the event site</option>
                    </select>
                    <span id="food_coordinator_fax_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-9 form-group mt-4 during_transportation_hot hideOnLoad">
                    <textarea type="text" class="form-control form-control-sm shadow mb-2 required mt-2"
                        id="during_transportation_hot" name="during_transportation_hot" placeholder="During transportation"></textarea>
                    <span id="during_transportation_hot_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-9 form-group mt-4 at_the_event_site_hot hideOnLoad">
                    <textarea type="text" class="form-control form-control-sm shadow mb-2 required mt-2" id="at_the_event_site_hot"
                        name="at_the_event_site_hot" placeholder="At the event site"></textarea>
                    <span id="at_the_event_site_hot_error" class="error text-danger"></span>
                </div>

            </div>
            <div class="row">
                <label class="col-form-label text-sm text-secondary">Indicate how foods will be
                    prepared (check all that apply)<span class="text-danger">&#42;</span></label>
                <div class="col-12">
                    <div class="row">
                        <div class="col-3">
                            <div class="form-group">
                                <div class="icheck-primary icheck">
                                    <input type="checkbox" name="prepared_at_licensed_facility"
                                        onchange="licensedFacility(this)" value="1"
                                        id="prepared_at_licensed_facility" class="form-check-input required">
                                    <label class="form-check-label text-secondary text-bold font-italic"
                                        for="prepared_at_licensed_facility">
                                        Prepared at licensed facility (list facility)
                                    </label>
                                    <br>
                                    <span id="prepared_at_licensed_facility_error"
                                        class="error text-danger ml-4"></span>

                                </div>
                            </div>
                        </div>
                        <div class="col-sm-9 form-group prepared_at_licensed_facility hideOnLoad">
                            <input type="text" class="form-control form-control-sm shadow mb-2 required"
                                id="prepared_at_licensed_facility_note" name="prepared_at_licensed_facility_note"
                                placeholder="Prepared at licensed facility (list facility)" />
                            <span id="prepared_at_licensed_facility_note_error" class="error text-danger"></span>
                        </div>
                    </div>
                </div>

                <div class="col-12">
                    <div class="row">
                        <div class="col-3">
                            <div class="form-group">
                                <div class="icheck-primary icheck">
                                    <input type="checkbox" name="prepared_at_the_event"
                                        onchange="preparedAtEvent(this)" value="1" id="prepared_at_the_event"
                                        class="form-check-input required" />
                                    <label class="form-check-label text-secondary text-bold font-italic"
                                        for="prepared_at_the_event">
                                        Prepared at the event
                                    </label>
                                    <br>
                                    <span id="prepared_at_the_event_error" class="error text-danger ml-4"></span>
                                </div>
                            </div>
                        </div>
                        <div class="col-sm-9 form-group prepared_at_the_event hideOnLoad">

                            <input type="text" class="form-control form-control-sm shadow mb-2 required"
                                id="prepared_at_the_event_note" name="prepared_at_the_event_note"
                                placeholder="Prepared at the event" />
                            <span id="prepared_at_the_event_note_error" class="error text-danger"></span>
                        </div>
                    </div>
                </div>
            </div>
            <div class="row">
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">List where food will be stored
                        prior to the event</label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required"
                        id="list_where_food_will_be_stored" name="list_where_food_will_be_stored"
                        placeholder="List where food will be stored prior to the event" />
                    <span id="list_where_food_will_be_stored_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">How will handwashing stations
                        be provided?</label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required"
                        id="handwashing_stations_be_provided" name="handwashing_stations_be_provided"
                        placeholder="How will handwashing stations be provided?" />
                    <span id="number_of_food_booths_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Location of food service
                        worker toilet facility</label>
                    <input type="text" id="location_of_worker_toilet" name="location_of_worker_toilet"
                        class="form-control form-control-sm shadow mb-2 required"
                        placeholder="Location of food service worker toilet facility" />
                    <span id="location_of_worker_toilet_error" class="error text-danger"></span>
                </div>

                <div class="col-sm-12 form-group">
                    <label class="col-form-label text-sm text-secondary">Describe how utensils, cutting
                        boards, etc. will be sanitized</label>
                    <textarea type="text" id="describe_sanitized" name="describe_sanitized"
                        class="form-control form-control-sm shadow mb-2 required"
                        placeholder="Describe how utensils, cutting boards, etc. will be sanitized"></textarea>
                    <span id="describe_sanitized_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Type of sanitizer </label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required"
                        id="type_of_sanitizer" name="type_of_sanitizer" placeholder="Type of sanitizer" />
                    <span id="type_of_sanitizer_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Test Strips</label>
                    <select id="test_strips" name="test_strips" class="form-control form-control-sm shadow mb-2">
                        <option value="">---Select---</option>
                        <option value="Yes">Yes</option>
                        <option value="No">No</option>
                    </select>
                    <span id="test_strips_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">What will be done with
                        leftovers? </label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required" id="leftovers"
                        name="leftovers" placeholder="What will be done with leftovers?" />
                    <span id="leftovers_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-6 form-group">
                    <label class="col-form-label text-sm text-secondary">Will there be a probe
                        thermometer to take internal temperatures of food products? </label>
                    <select id="internal_temperatures" name="internal_temperatures"
                        class="form-control form-control-sm shadow mb-2">
                        <option value="">---Select---</option>
                        <option value="Yes">Yes</option>
                        <option value="No">No</option>
                    </select>
                    <span id="internal_temperatures_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">Water supply (used for cooking
                        and hand washing)</label>
                    <select id="water_supply" name="water_supply" class="form-control form-control-sm shadow mb-2 ">
                        <option value="">---Select---</option>
                        <option value="Yes">Public Water</option>
                        <option value="No">Private Well</option>

                    </select>
                    <span id="water_supply_error" class="error text-danger"></span>
                </div>


                <div class="col-sm-6 form-group">
                    <label class="col-form-label text-sm text-secondary">How will food items be
                        protected from public exposure (sneezing, coughing, touching, etc.) and outdoor
                        elements</label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required"
                        id="outdoor_elements" name="outdoor_elements" placeholder=" " />
                    <span id="outdoor_elements_error" class="error text-danger"></span>
                </div>
                <div class="col-sm-3 form-group">
                    <label class="col-form-label text-sm text-secondary">How will grease and/or
                        wastewater be disposed of? </label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required"
                        id="wastewater_be_disposed" name="wastewater_be_disposed"
                        placeholder="How will grease and/or wastewater be disposed of?" />
                    <span id="wastewater_be_disposed_error" class="error text-danger"></span>
                </div>

                <div class="col-sm-12 form-group">
                    <label class="col-form-label text-sm text-secondary">Include a drawn layout of your
                        food booth with this application (Label all refrigerators, steam tables, stoves,
                        grills, handwash stations, garbage cans, food storage areas, cleaning product
                        storage, etc.) </label>
                    <input type="text" class="form-control form-control-sm shadow mb-2 required"
                        id="include_a_drawn_layout" name="include_a_drawn_layout" placeholder="" />
                    <span id="include_a_drawn_layout_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 class="col-md-4 col-lg-4 col-sm-4 col-xs-4">
                                        <div class="icheck-marine">
                                            <input type="checkbox" id="applicationInPersonCheck" name="applicationInPersonCheck"/>
                                            <label for="applicationInPersonCheck">
                                               Application Submitted in Person
                                            </label>
                                        </div>
                                    </div> --}}
                </div>
            </div>
        </div>
    </div>
    
</form>