3331 BROADWAY HOPEWORKS STATION 2016-09-22

• � SNOHOMISH HEALTH DISTRICT W W W.SNOHD.ORG Facility name CafeWorks at HopeWorks Station � Food Establishment Plan Review Checklist This checklist will help you prepare a complete plan review application. Check off each item in the plan review application packet and provide items in the following order. Submit the completed plan review packet and checklist with the required application fee. Make a copy of this plan review packet for your file prior to submittal. Plan review fees are non-refundable Office ITEM DESCRIPTION Use Onl Intake 1 Water and sewer Provide proof that the facility is connected to an approved water and sewer or septic adequacy system. 2 Application Provide complete application. Include a copy of your business license. 3 Plan review Provide complete Plan Review Questions form. questions 4 Floor plan Provide a floor plan of the entire facility. Floor plan must show location of all equipment (sinks, refrigeration, cooking, hoods, blenders, countertop appliances, etc.), restrooms, storage areas, etc. Floor plan must be no smaller than '/4 equals 1'. 5 Equipment list Provide make and model numbers of all equipment (including countertop appliances). Show location on floor plan. For remodels both new and existing equipment must be shown on the floor plan. Only commercial grade, National Sanitation Foundation (NSF) or equivalent, equipment is acceptable. 6 Finish schedule Provide the materials used for all floors, walls, ceilings, counters, and cabinets. 7 Menus Provide a detailed menu of all the food and beverages you will be serving or a list of food and beverages you will be selling. Include condiments, iced beverages and baked goods. Be sure to include specials and seasonal items. Only food and beverages listed may be served. All breakfast, dinner, lunch, barllounge, happy hour, kids, catering, and online menus must be submitted. 8 Food sources Provide a list of all food and beverage suppliers. 9 Food preparation Provide a description of how each menu item will be prepared. steps 10 Waste disposal Provide complete Waste Disposal form. 11 Supplemental Provide complete Supplemental Question form(s) if applicable. questions (catering and food processing) 12 Fee Include application fee. Provide separate checks forwater review and plan review. I understand I cannot open this food establishment until I have received written approval from this program, obtained all annual operating permits and have been inspected and approved by all applicable city, county and state agencies. Signature/Title Date Environmental Health Division 3020 Rucker Avenue, Suite 104 ■ Everett, WA 98201-3900 ■ fax: 425.339.5254 ■ tel: 425.339.5250