3331 BROADWAY HOPEWORKS STATION 2016-09-22

� SNOHOMISH � � '� HEALTH DISTRICT W W W.SNOHD.ORG Water and Sewer Adequacy / Food & Community Safety C f"W k t H W k St ' Facility name a e or s a ope or s ation Site address 3331 Broadway City Everett Parcel number 00439079600500 Contact name Ross Latham Email rosslatham@hopewrks.org State WA ZIP 98201 Proposed number of seats Phone 425.610.4931 Fax 425.903.4913 ❑ New construction � Remodel/Alteration ❑ Expansion of existing restaurant 0 Yes ❑ No Is facility connected to a septic system? ❑ Yes ❑ No Are public restrooms available? ❑ Yes ❑ No Is a grease trap required by sewer district or building department? HEALTH DISTRICT USE ONLY ❑ Pre-approved water system Describe the proposed project: Opening of a cafe that serves coffee and espresso beverages, pastries, grab and go items, bottled beverages, and sandwiches. Sewage system O Sewer bill attached ❑ Below completed by officiai This section should be completed by a Public Sewer System Official, if a sewer bill or availability letter is not provided. Name of system Sewer utility The above system will provide service to the facility listed at the above address. System official Phone 425.404.3462 Date Water system This section should be completed by a Public Water System Official, if a water bill or availability letter is not provided. Name of system The above facility � is connected ❑ has applied State ID number The above system will provide service to the facility listed at the above address. System official Phone Date HEALTH DISTRICT USE ONLY On-site Approved to submit (signature) _ Final septic approved (signature) Water Name of water system ❑ Not adequate for use ❑ Adequate for use (signature) Comments Date Date State ID Number _ Date Environmental Health Division 3020 Rucker Avenue, Suite 104 ■ Everett, WA 98201-3900 ■ fax: 425.339.5254 ■ tel: 425.339.5250