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Food Establishment / Business Information

Type of Ownership
1. Corporation
2. LLC
3. Partnership
1. Sole Proprietor
2. Other
Owner Name(s)
Mailing Address
City
State
Zip Code
Phone
Cell Phone
Email
The following documents must be attached:
Floor Plan
- All equipment is located on the floor plan and labeled (sinks, refrigeration, blenders, etc.)
- Remodel shows existing conditions and proposed plans
- Floor plan shows entire facility including restrooms and storage areas
Equipment Schedule
- Equipment list provides brand and model # of each piece of equipment
- Only NFS or equivalent equipment
- Hot water heater recovery rate provided
Finish and Plumbing Schedule
- Material type is clearly provided for ceiling, walls, flooring, coving for all areas
- Plumbing schedule correctly demonstrates which fixture is directly or in directly drained
Menu
- Proposed menu provided
- All food items and drinks are listed
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By signing this form, you attest to the accuracy of the information provided, affirm that you will comply with Chapter 246-215 WAC, and will allow NETCHD access to the establishment and its records as specified in Chapter 246-215 WAC. You agree to notify NETCHD in advance of changes in menu, equipment, operation, or ownership.
eSignature
Date
Date

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