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(17* Q SNOHOMISH <br /> 0o COUNTY444, <br /> HEALTH DEPARTMENT General Food Plan Review Checklist <br /> Facility name: <br /> Revive Bowls <br /> This checklist will help you prepare a complete plan review packet. Incomplete plan review packets will not be accepted. <br /> 0 ITEM DESCRIPTION <br /> 1 Plan Review Complete the Plan Review Questionnaire form. <br /> Questionnaire <br /> 2 Water and Sewer Complete the Water&Sewer Review form. <br /> Review <br /> Provide make and model numbers of all equipment including countertop appliances <br /> ✓ 3 Equipment List and plumbing fixtures. Show location on the floor plan. Only commercial grade, National <br /> Sanitation Foundation (NSF)or equivalent equipment is acceptable. <br /> 4 Finish Schedule Complete the Finish Schedule form. Provide the materials used for all floors,walls, <br /> ceilings, counters and cabinets. <br /> 5 Food Sources Complete the Food Sources form. Include general descriptions of what food items will be <br /> received from each supplier. <br /> Catering Questionnaire <br /> ❑ Provide complete Catering Questionnaire if applicable along with all other requested <br /> 6 documents as stated in that form. For caterers utilizing a commissary kitchen, the <br /> Commissary Agreement form should also be included. <br /> 7 Floor Plan Provide a floor plan of the entire facility. Floor plan must show location of all equipment <br /> Wel (sinks, refrigeration, cooking, hoods, blenders,countertop appliances,etc.), restrooms, <br /> storage areas,outdoor cooking areas, etc. Floor plan must be drawn to scale, and <br /> measurements included. <br /> 8 Menu(s) Provide a detailed menu(s)of all the food and beverages you will be serving.All <br /> breakfast, lunch, dinner, bar/lounge, happy hour, kids, catering, and other menus must be <br /> submitted. <br /> 9 Food Preparation Steps Provide a detailed description of how all food and beverages will be prepared using the <br /> provided description and examples as a guide. <br /> Provide a copy of your Washington State Department of Revenue issued <br /> Fv 10 Business License business license. <br /> ZI11 Fee Include application fee. <br /> ECO General Food Checklist 2.7.241t <br /> Environmental Health Division <br /> 3020 Rucker Avenue, Suite 104 0 Everett, WA 98201-3900 0 fax: 425.339.5254 0 tel: 425.339.5250 <br />