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SNOHOMISH <br /> HEALTH DISTRICT Food Establishment Plan Review Checklist <br /> WWW.SNOHD.ORG <br /> Facility name <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 /> ✓ ITEM DESCRIPTION Use Only <br /> Intake <br /> "7,1 Water and sewer Provide proof that the facility is connected to an approved water and sewer or septic <br /> adequacy system. Gl �� <br /> 2 Application Provide complete application. Include a copy of your business license. <br /> —1_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 /> (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 /> C 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 /> C -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 /> 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 /> .8 Food sources Provide a list of all food and beverage suppliers. <br /> 1---9f Food preparation Provide a description of how each menu item will be prepared. <br /> steps <br /> C10 Waste disposal Provide complete Waste Disposal form. <br /> r— 11 Supplemental Provide complete Supplemental Question form(s)if applicable. <br /> questions (catering and food processing) <br /> 12 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 permits and have been inspec -.d and approv by all applicable city, county and state agencies. <br /> Signature/Title 1E%` �' � x Date 7-27•-ii-7 <br /> Environmental Health Division <br /> 3020 Rucker Avenue,Suite 104 ■ Everett,WA 98201-3900 IN fax: 425.339.5254 ■ tel:425.339.5250 <br />