2814 RUCKER AVE 2025-04-07 - Laserfiche WebLink

FQ SNOHOMISH COUNTY4W HEALTH DEPARTMENT General Food Plan Review Application Application must be completed in full and submitted with fee(s) and the items listed for processing: Reviewed by: PA Initials: TYPE OF PLAN REVIEW(Check applicable box) $815 (PE 5672)General Food Plan Review New food service establishment plan review and pre-operational inspection fee $205 (PE 5670)Tap Room/Tasting Room New tap room/tasting room plan review and pre-operational inspection Plan Review fee $815 Multiple Permit Facility General Plan New multiple permit food service establishment. Review base fee plus $205 for each additional New food service establishment with multiple permits(I.e., deli, permit(PE 5676&PE 5675) meat/fish, etc.). Fee includes plan review and pre-operational inspection. $410 (PE 5642)Change of Ownership Change of ownership includes inspections. $205 (PE 5685)Alteration to Existing Alteration to currently permitted food service establishment or revision Establishment/Approved Plan of approved plan. Includes plan review and pre-operational inspection. $205 (PE 5677)Consultation Fee Plan review consultation (on or offsite) $2000 (PE 5683) HACCP Review(with or Hazard Analysis Critical Control Point (HACCP) plan review with or without variance) without a variance — when required by WAC for food proposed food preparation steps. Includes plan review and pre-operational inspection. $205(PE 56AM)Variance Request without Variance request without HACCP Plan review. Includes plan review and HACCP Review pre operational inspection. ESTABLISHMENT INFORMATION ESTABLISHMENT MAILING ADDRESS Establishment Name: Name: Site Address: Mailing Address: City: ZIP: City: State: ZIP: OWNER INFORMATION Name: Phone: Address: E-mail Address: City: State: Zip: CONTACT INFORMATION (if different than owner) Name: Phone: Address: E-mail Address: City: State: Zip: Review is based upon requirements of WAC 246-215; Rules & Regulations of the State Board of Health for Food Service Sanitation. Other agency approvals required prior to permitting with the Snohomish County Health Department may include county or city Planning, Building, Plumbing and Fire Departments, Water and Sewer Utilities. Signature of the owner or appointed contact person affirms the accuracy of the information provided in this application and that the permitted facility will be operated in compliance with the rules of the Washington State Retail Food Code. Signature: Date: Print Name: