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SNOHOMISH <br /> HEALTH DISTRICT <br /> •---- W W W.SNOHD.ORG New Restaurant Plan Review Checklist <br /> Facility name: /,!AA(:ri.f'IL� <br /> This checklist will help you prepare a complete plan review packet. Submit the completed plan review packet and checklist <br /> with the required application fee. Incomplete plan review packets will not be accepted. Make a copy of this plan review <br /> packet for your records prior to submittal. Plan review fees are non-refundable. <br /> ✓ ITEM DESCRIPTION Office <br /> Use Only <br /> Intake <br /> n1 Application Provide complete Food Plan Review application. <br /> 2 Water and Provide proof that the facility is connected to an approved water and sewer or <br /> I " 1 sewer septic system. <br /> adequacy <br /> I I 3 Plan review Provide complete Plan Review Questionnaire form. <br /> questionnaire <br /> 4 Floor plan Provide a floor plan of the entire facility. Floor plan must show location of all <br /> equipment(sinks, refrigeration, cooking, hoods, blenders, countertop appliances, etc.), <br /> restrooms, storage areas, etc. Floor plan must be no smaller than 1/4 equals 1'. <br /> • <br /> 5 Equipment list Provide make and model numbers of all equipment(including countertop <br /> appliances). Show location on floor plan. For remodels both new and existing <br /> equipment must be shown on the floor plan. Only commercial grade, National <br /> Sanitation Foundation (NSF)or equivalent equipment is acceptable. <br /> 6 Finish Provide the materials used for all floors,walls, ceilings, counters,and cabinets. <br /> schedule <br /> 17 7 Menus Provide a detailed menu of all the food and beverages you will be serving or a list <br /> of food and beverages you will be selling. Include condiments, iced beverages and <br /> baked goods. Be sure to include specials and seasonal items. Only food and beverages <br /> listed may be served. All breakfast, dinner, lunch, bar/lounge, happy hour, kids, <br /> catering,and online menus must be submitted. <br /> • <br /> pi8 Food sources Provide a list of all food and beverage suppliers. <br /> 9 Food Provide a description of how all menu items will be prepared. <br /> preparation <br /> steps <br /> 10 Waste disposal Provide complete Waste Disposal form. <br /> 11 Supplemental Provide complete Supplemental Question form(s) if applicable. <br /> questions (catering and food processing) N/f-1 <br /> ri12 Fee Include application fee. <br /> I understand I cannot open this food establishment until I have received written approval from this program, obtained all <br /> annual operating permits and have been inspected and approved by all applicable city, county and state agencies. <br /> Signature/Title \641 1/vk Date 27'2-4)I 241I <br /> Environmental Health Division - - , <br /> 3020 Rucker Avenue, Suite 104 ■ Everett, WA 98201-3900 ■ fax: 425.339.5254 ■ tel: 425.339.5250 ( �J <br />