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'(Q SNOHOMISH <br /> lit& HEALTH DISTRICT Food Establishment Plan Review Checklist <br /> WWW.SNOHD.ORG <br /> Facility name Eight Ball Cafe <br /> This checklist will help you prepare a complete plan review application. Check off each item in the plan review application <br /> packet and provide items in the following order. Submit the completed plan review packet and checklist with the required <br /> application fee. Make a copy of this plan review packet for your file prior to submittal. Plan review fees are non-refundable <br /> Office <br /> Use Only <br /> ✓ ITEM DESCRIPTION Intake <br /> F,1 1 Water and sewer Provide proof that the facility is connected to an approved water and sewer or septic <br /> Iv I adequacy system. <br /> E2 Application Provide complete application.Include a copy of your business license. <br /> 3 Plan review Provide complete Plan Review Questions form. <br /> questions <br /> 4 Floor plan Provide a floor plan of the entire facility.Floor plan must show location of all equipment <br /> E (sinks, refrigeration,cooking,hoods, blenders,countertop appliances,etc.), restrooms, <br /> storage areas, etc. Floor plan must be no smaller than'/ equals 1'. <br /> 5 Equipment list Provide make and model numbers of all equipment(including countertop <br /> E. 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 /> I✓ 6 Finish schedule Provide the materials used for all floors,walls,ceilings,counters,and cabinets. <br /> 7 Menus Provide a detailed menu of all the food and beverages you will be serving or a list of <br /> food and beverages you will be selling.Include condiments, iced beverages and baked <br /> C goods. Be sure to include specials and seasonal items. Only food and beverages listed <br /> may be served. All breakfast,dinner,lunch,bar/lounge,happy hour,kids,catering, <br /> and online menus must be submitted. <br /> C8 Food sources Provide a list of all food and beverage suppliers. <br /> 9 Food preparation Provide a description of how each menu item will be prepared. <br /> C steps <br /> C10 Waste disposal Provide complete Waste Disposal form. <br /> 11 Supplemental Provide complete Supplemental Question form(s)if applicable. <br /> C✓ questions (catering and food processing) <br /> C12 Fee Include application fee.Provide separate checks for water review and plan review. <br /> I understand I cannot open this food establishment until I have received written approval from this program, obtained all <br /> annual operating ptirmits and have been inspected and approved by all applicable city, county and state agencies. <br /> 8 <br /> Signature/Title 1`\-l'.\-kl. A101 -i ' k tA) r\/�-4 , Date <br /> tjy \ ' --,9-0(`7 <br /> i <br /> , <br /> t <br /> Environmental Health Division ,,;.r_ <br /> 3020 Rucker Avenue,Suite 104 ■ Everett, WA 98201-3900 ■ fax:425.339.5254 a tel: 425.339.5250 t / / <br />