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199 N Olympic Ave_BLD3104_2026
NOTICE C TO PERMITEE AND/OR OWNER ❑ PARTIAL APPROVAL ❑ CORRECTIONS REQUIRED ❑ DO NOT OCCUPY APPROVED PERMIT#: LAM]PM IDATE: -. �—��✓ OBADDRESS: 11�1 t`� ��<� ;j`,tl It - LOT#: PROJECT: (0/h_ I( TYPE OF INSPECTION: ''x'T'> OTHER: Ae ❑ NO PERMIT-STOP WORK-OBTAIN PERMIT ❑ CONSTRUCTION IS NOT IN ACCORDANCE WITH APPROVED PLANS AND PERMIT -STOP WORK ❑ STOP WORK UNTIL AUTHORIZED TO CONTINUE BY INSPECTOR. ❑ CORRECTIONS LISTED BELOW MUST BE MADE BEFORE WORK CAN BE APPROVED. ❑ WORK NOT READY FOR INSPECTION:$50 REINSPECTION FEE (PER IBC) MUST BE PAID PRIOR TO NEXT INSPECTION. ❑ CONTACT INSPECTOR 360-403-3551 Cl CALL FOR REINSPECTION i :&_"lg a-)I \-emcgo a THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED WITHIN DAYS OR PENALTIES IMPOSED BYLAW MAYAPPLY FOR INSPECTION CALL: 360-403-3417 INSPECTOR DATE O PLANNING 0 CIVIL L-T BUILDING CITY OF ARLINGTON Y r CITY OF ARLINGTON 238 N.OLYMPIC AVE-ARLINGTON, WA. 98223 1W PHONE,(360)403-3551 BUILDING PERMIT Address:119 N.Olympic Ave. Permit p:3104 Parcel if:00379800601600 Valuation:6300.00 OWNER APPLICANT CONTRACTOR Name:OLYMPIC SG LLC Name:Nicole Minton Name: Address:4820 FOWLER AVE Address:5226 257111 St NE Address: City,Slate Zip:EVERETT,WA 98203-3214 City,State Zip:Arlington,WA 98223 City,State Zip;, Phone: Phone:425-3 18-9954 Phone' LIC: EXP: MECHANICAL CONTRACTOR PLUMBING CONTRACTOR Name Name: Address Address: City,State,Zip: City,Slate,Zip: Phone: Phone: LIC#: EXP: LIC tf EXP: JOB DESCRIPTION PERMITTYPE Commercial Mechanical CODE YEAR: 2015 STORIES: CONST TYPE: DWELLING UNITS: OCC GROUP: BUILDINGS: OCC LOAD: PERMIT APPROVAL I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY: NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE.AND RCW 18.27 THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID, IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. IBCI 10/IRCI 10. SALES TAX NOTICE.:Sales lax relating to construction and construction materials in the City of i gton muss reported on your sales tax returZ27/-Z, and rndcd 'ity Ariin 113101. , t 0 J, 20 S413—tc Print Name 13.4 RcI sctl By Date CONDITIONS Adhere to approved plans.Call for inspections. THIS PERMITAUT14ORIM ONLY THE WORK NOTED THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS,MARQUEES.ETC.)WILL REQUIRE SEPARATE PERMISSION PERMIT FEES Dale Description Fee Amount 03r27/2020 Commercial Hoods $25.00 03f27/2020 Mechanical Commercial Plan Review $135.01 0327/2020 Processing/Technology Fee $25.00 03/272020 Mechanical Misc. $15.00 Total Due: S200.01 Total Payment: 50.00 Balance Due: $200.01 CALL FOR INSPECTIONS H U I LD I NG(360)403-3417 When calling for an Inspection pkase leave the following Information: Permit Number,Type of Inspectloa being requested,and whether you prefer morning or afternoon .. I f ' CITY OF ARLINGTON ( ' 238 N. OLYMPIC AVE - ARLINGTON, WA. 98223 PHONE; (360) 403-3551 BUILDING PERMIT Address:119 N.Olympic Ave. Permit#:3104 Parcel#:00378800601600 Valuation:6300.00 OWNER APPLICANT CONTRACTOR Name:OLYMPIC SG LLC Name:Nicole Hinton Name: Address:4820 FOWLER AVE Address:5226 257th St NE Address: City,State Zip:EVERETT,WA 98203-3214 City,State Zip:Arlington,WA 98223 City,State Zip:, Phone: Phone:425-318-9954 Phone: LIC: EXP: MECHANICAL CONTRACTOR PLUMBING CONTRACTOR Name: Name: Address: Address: City,State,Zip: City,State,Zip: Phone: Phone: LIC#: EXP: LIC#: EXP JOB DESCRIPTION PERMIT TYPE: Commercial Mechanical CODE YEAR: 2015 STORIES: CONST.TYPE: DWELLING UNITS: OCC GROUP: BUILDINGS: OCC LOAD: PERMIT APPROVAL I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY; NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID. IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. IBC110/IRC110. SALES TAX NOTICE:Sales tax relating to construction and construction materials in the City of t gton must b•reported on your sales tax return forth and coded City of Arlington#3101. 13L Zo20 Signature Print Name Date Rcle sed By Date CONDITIONS Adhere to approved plans. Call for inspections. THIS PERMIT AUTHORIZES ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS,MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION. PERMIT FEES Date Description Fee Amount 03/27/2020 Commercial Hoods $25.00 03/27/2020 Mechanical Commercial Plan Review $135.01 03/27/2020 Processing/Technology Fee $25.00 03/27/2020 Mechanical Misc. $15.00 Total Due: $200.01 Total Payment: $0.00 Balance Due: $200.01 CALL FOR INSPECTIONS BUILDING(360)403-3417 When calling for an inspection please leave the following information: Permit Number,Type of Inspection being requested,and whether you prefer morning or afternoon I - - - - - - - I l 3 Z 3 Zp Permit#: 3104 Permit Date: 03/19/20 Project Name: Chaotic Cookie Bakery Site Address: 119 N. Olympic Ave. Company/Applicant Name: Nicole Hinton Company/Applicant Address: 5226 257th St NE City, State, Zip: Arlington, WA 98223 Contact: Nicole Hinton Phone: 425-318-9954 Email: chaoticcookiebakery@gmail.com Permit Type: Commercial Mechanical Valuation: 6300.00 Square Feet: 0 Number of Stories: 0 Type of Construction: Occupancy Type: Scope of Work: Install 36"x42" hood MIC/Opportunity Zone: Permit Issued: Permit Expires: DNU: Status: IN PROCESS Property Parcel# Address Legal Description Owner Name Owner Phone Zoning 569 Other Retail 00378800601600 119 N OLYMPIC AVENUE OLYMPIC SG LLC Trade-Apparel& Accessories NEC Plan Reviews Date Review Type Description Assigned To Review Status 03/19/2020 Commercial Mechanical Building In Review Fees Fee Description Notes Amount Commercial Hoods Type I/II $25.00 Mechanical Commercial Plan Review Table 4-8;65%permit fee $135.01 Processing/Technology Fee $25.00 Mechanical Misc. Not otherwise specified oven $15.00 Total $200.01 Uploaded Files Date File Name 03/19/2020 6409957-Re Inspection Request.msg 03/19/2020 6409956-attachments CO20021000138396506 111YTtFrUUQO]]ATd70j 9]AD5s1CR9S.pdI 03/19/2020 >409955-3104 Application.pdf COMMERCIAL MECHANICAL APPLICATION Community&Economic Development City of Arlington• 18204 59th Ave NE•Arlington,WA 98223• Phone(360)403-3551 This application is for new,addition,altered or replaced mechanical installation and new or altered gas piping and must be accompanied by ELETRONIC FILES and TWO (2) SETS OF CONSTRUCTION DRAWINGS and CUT SHEETS and/or information outlined in the MECHANICAL SUBMITTAL REQUIREMENTS,if applicable. Type of Permit: 0 New Installation Cl Addition ❑ Alteration ❑ Replaced ❑ Gas Piping Property Address: 119 north Olympic ave Project Valuation: 6300.00 Lot#: Parcel ID No.: Preferred Contact: 0 Owner O Contractor Project Description: Bakery Owner Name: Nicole Hinton Home No.: Email Address: Chaoticcookiebakery@gmail.com Cell No.: 4253189954 Mailing Address: 5226 257th st ne sty. Arlington State: Wa Zip: 98223 Contractor Name: Xxxxx Office No.: Email Address: Xxxxxx Cell No.: Xxxxxxxxxx Mailing Address: Xxxxx City: Xxxx State: Xx Zip: XxXXX L&I Contractor License Number: Xxxxxxxx Expiration Date: Xxxxxx • New gas piping requires a pressure test hooking to any appliance • Sediment traps(drips) are required on all gas lines • Gas lines are required to be supported/secured per IFGS,Section 415. • Proper Combustion air and venting required for all appliances • A shut-off valve is required within 6 feet of all appliances Gas Piping Specification and complete Schematic PAGE 3 0 Not Applicable 0 CSST O Brass O Other Proposed Piping Material: 0 Black Steel O Galvanized Steel Proposed Piping Size: 0 1/2" 0 5/8 O 3/a" O 1" 0 11/z" 0 2" Inlet Pressure: Pressure Drop: Specific Gravity: I hereby certify that the above information is correct and that the construction on,and the occupancy and the use of the above described property will be in accordance with the laws,rules and regulation of the State of Washington. Nicole Hinton March 19, 2020 Signature Print Name Re!-J-!iV VAC 'OR STAFFUSrAb PERMIT ii ACCEP BY: DATE STAMP REV2.2020 Pagel of3 MECHANICAL PERMIT FEES (per unit Type of Fixture No.of Units Cost per Unit Subtotal Additional Plan Review fees x $75.00 = Is 0 Air Cond Unit<_100Btu h x $15.00 = $ 0 Air Cond.Unit>100Btu h x $25.00 = $ 0 Air Cond.Unit>500Btu i x $50.00 = $ 0 Air Handling Units x $15.00 = $ 0 Base Mechanical Fee $25.00 $25.00 Boiler<10OBtujh>3h x $15.00 = $ 0 Boiler>1 million Btufli<50h x $25.00 = $ 0 Boiler>1.5 million Btu <50h x $50.00 = $ 0 Boiler>100Btu 3-15h x $15.00 = $ 0 Boiler>5 0 0 Btufh15-3 Ohp x $25.00 = $ 0 Commercial Hoods-Type I x $25.00 = $ Commercial Hoods-lype 1I x $50.00 = $ Diffusers x $15.00 = $ 0 Dryer Ducting x $15.00 = $ 0 Ductwork(drawings required) x $25.00 = $ Evaporative Coolers x $15.00 = $ Exhaust/Ventilation Fans x $15.00 = $ Fireplace/Insert/Stove x $15.00 = $ Forced Air Heat<100 Btu h x $15.00 = $ Forced Air Heat>100 Btu h x $25.00 = $ 0 Gas Clothes Dryer x $15.00 = $ 0 Gas FiredAC 15100 Btu x $15.00 = $ 0 Gas Fired AC>100 Btu i x $25.00 = $ 0 Gas Fired AC>500 Btu x $50.00 = $ 0 Gas Pi in <_ 5 units x $15.00 = $ 0 Gas Piping> 5 units (plus<5 units x $2.00 = $ 0 Heat Exchangers x $15.00 = $ 0 Heat Pump-Go ndensin Unit x $25.00 = $ 0 Hot Water Heat Coils x $15.00 = $ 0 Miscellaneous Appliance-regulated by x $15.00 = $ 0 mechanical code,not otherwise specified Pk .Units 5100btu x $25.00 = $ 0 Pkg. Units>100btu x $50.00 = $ 0 Ran a Cookto Gas Fired x $15.00 = $ 0 Refrigeration Unit<_100Btu h x $15.00 = $ 0 Refrigeration Unit>10OBtufh x $25.00 = $ 0 Refrigeration.Unit>500Btu h x $50.00 = $ 0 Re-inspection fee all x $75.00 = $ 0 Residential Range Hood x $15.00 = $ 0 Unit Heaters 15 100 Btu h x $15.00 = $ 0 Unit Heaters>100 Btu h x $25.00 = $ 0 VAV Boxes(Variable Air Volume,part of air x $10.00 _ $ 0 conditioning system) Wall Heaters-Gas Fired x $25.00 = $ 0 Water Heater- Gas Fired x $25.00 = $ 0 Permit Fee $ 25 Table 4-8; Plan Review Fee $ Processing/Technology Processing/Technology Fee $25.00 Total $ REV2.2020 Page 2 of3 MAINTENANCE The motor and the fan wheel should be periodically inspected. Urricaile Inspect every six months if continuously operated. The appliance maintenance shall be carried out only by qualified persons. " All fasteners should be checked to make sure they are securely tightened. INLINE FAN SERIES In addition,all rotating items should be checked for easy mobility.When INSTRUCTION SHEET inspecting the unit,disconnect it from the power supply and any duct work. If debris is evident on the impeller,clean it with a damp[not wet]cloth. M1 DO NOT use detergents or abrasive materials for cleaning. Hurricane Inline Fan Specifications PART# SIZE VOLTS AMPS WATTS CFM RPM WEIGHTAB. 736570 4" 120 0.95 113 171 2910 8 736575 6" 120 0.97 115 435 2915 9 7365,90 8" 120 1.72 198 745 2530 12 736585 10" 120 2.1 236 780 2480 12 736590 12" 120 2.5 300 1060 2575 16 BRACKET MOUNTING OPTIONS Please read instructions carefully before using this op product. Manufacturer will not be held responsible P and declines any and all liability for damage caused P to persons or property due to improper use with reference to the precautions outlined in this manual. \ This manual explains how to correctly install, use and • perform maintenance on HurricaneTm inline fans. Follow these / instructions to ensure that the product will be electrically and mechanically reliable and extend its service life. Remove the inline fan from its package,and visually inspect for damage. Make sure that the fan housing and the fan wheel are not damaged. • The fan wheel should rotate freely without catching or scraping the internal housing and be securely fastened to its rotation shaft. Contact a qualified person or place of purchase if there are any questions about the Huricane inline fan. FIVE YEAR • Do not leave packing materials within reach of children.Do not dump any WARRANTY materials into the environment[polystyrene,plastic,polypropylene,etc.]. • If the product is dropped or the box is damaged,immediately contact Hurricane your retailer to check that the product operates properly. www.hurricane-fans.com CITY OF ARLINGTON BUILDING DEPARTMENT APPROVED DATE 3 Z 3 BY :.eceived NO CHANGES AUTHORIZED UNLESS APPROVED BY THE MAR 19 ZOZ® BUILDING INSPECTOR -n J KEEP THESE INSTRUCTIONS READILY AVAILABLE INSTALLATION The installer must read the following instructions very carefully before GENERAL PRECAUTIONS using the product.The manufacturer will not be held responsible for injury to persons or damage to property due to improper use with reference to The use of electrical devices require compliance with these basic rules: the precautions outlined in these instructions. • DO NOT touch the device with wet hands,wet clothing,etc. • Do not exhaust hazardous or explosive vapors.For general ventilation • NEVER allow the unit to directly contact wet or moist environments. use only. • DO NOT allow the product to be operated by children or unskilled people. • The device must be installed by a professionally qualified electrician in • NEVER place anything near or in the intake or exhaust ports of fan. accordance with all applicable codes and standards,including fire-rated construction. Connect the product to the main power supply or electrical outlet only if: • To ensure optimum operation,do not block the air intake and exhaust • Your electrical voltage and frequency corresponds to those shown on vents.CAUTION:this unit has an unguarded impeller.DO NOT use in the rating plate. locations readily accessible to people or animals. • The main power supply is sufficient to operate the product at its maximum power. MODE OF INSTALLATION Wear gloves to safely move and/or install this inline fan. If power supply is not sufficient,contact professionally qualified personnel. Secure the Hurricane Inline Fan with clamps when attaching ducting • It is recommended that the product is switched off when not in use. [see Fig.1]. • Before carrying out any maintenance or cleaning,disconnect from the The wiring diagram is directly under the contact box cover(Fig.2). power supply. When all electrical connections are complete,check that the connection • If a fault,malfunction or anomaly of any type occurs,disconnect from terminals are securely tightened,close the box lid and start the inline fan. power supply and immediately contact qualified personnel. NOTE:Because this fan comes pre-wired with a standard 120 volt power cord,no additional wiring modifications are necessary Always request original parts for any repairs. • If the product needs to be removed,turn off main circuit breaker and After the inline fan has started,check to make sure: then disconnect the device from that circuit. -The rotation direction is correct. Place the device in a safe location far from children and/or pets. The absorbed current corresponds to the rating. The electrical system to which the fan is connected must comply with Excessive vibrations compromise the appliance stability. the current standards&codes regarding electrical systems for the parts concerning the application of our devices. SPECIAL PRECAUTIONS • The Hurricane Inline Duct Fan is professionally manufactured and complies with the current standards regarding electrical equipment. • Do not use the product at an ambient temperature greater than 40°C[104°F). t FIGURE 1 • Do not allow the product to be exposed to rain,sun,snow,etc. • Do not place the device or relative parts in water or liquids. 8FOR, c • When cleaning or performing routine maintenance,check the condition of the device.Please see Maintenance Section for proper cleaning. -1 • To avoid risk of fire,do not use the product in the presence of flammable - substances or vapours such as alcohol,insecticides,gasoline,etc. N FIGURE 2 Hurricane hurricane 1►?�,�r. r .Nip . . rt ,11 1 ()p � 1 F+ 0 flsk i 12 6 � i ji + + � 2D i 17 1 I LQ 16 . 15 Iq . . 1,018 �s 13 112 72 In i I 19 l i l NA OLYMPIC SG LC 104890-01 4 City ®f Arlington 11/01/2019 1 238 N. Olympic Ave, I Arlington,WA 98223 119 OLYMPIC N ;1c I 360.403,3421 1�0/31/2(019 �11/20/2�019 $342. 70 10/0112019 AMOU"11' CHAnGFS - PREVIOUS READIN PHESEN IREADING GONSt 11A 272426 272931 505 s Balance 347.25 Pay your bill online www.xpressbfllpay.com You will be able to process 3 One-time P r e v i ou 0.00 payment.set up Auto pay and go Pfiftelloss.Click an the Sign Up button on the lop of Adjustments It home screen.Fill In the email and password fields,than click I'm not a robot and -347.25 a Payments InIjoW the prompts.Complete the short registration form and click Next.Go to your .-;mail Inbox,open the verification email,and click Verify Email.Then select Continue to log In.Select City of Arlington and follow the prompts for linking your bill. Water Base 44.96 Water COIISLIIIII)t"1011 Water Usag 14.85 3000 Sewer 216.00 6.89 Stornivia.ter 2000 Ambul (ice Utility Fee 60-00 Curr nt Charges 342.70 1000 A, 0 Oct Nov Doc inn Foil Afar Apr MAy Jun Jul Aug Sep Oct wjej u, ovin Post 12 Moriffm MAKE CHECKS PAYABLE TO CITY OF ARLINGTON $342.70 TOTAL DUE11II* KEEP THIS PORTION FOR YOUR RECORDS LEASE READ THE BACK F9 IMPORTANT BILLING AND PAYMENT INFORMATION. 7.12 - - - - - - - - - - - - - - - - - - - - - - -- - -- - - - - - - - - - - - - - - - - - - - A11 1�01V.4 !f 723(1 7/18 PLEASE RETIUR� PORTION WITH YOUR PAYMENT. 11 11/01/2019 104890.01 City of Arlington j - 238 N.Olym pic Ave. Service Address: 11/20/2019 Ar1irIqt0lZWA 98223 119 OLYMPIC N 360.4 .3421 AMOUNT nn ENCLOSED s p cessed accurately. 111is sluil e,,7sj1j,6s tjj your- payment j Please Make Check Payable To Name gelow: Z12 AUTO ALL. FOR AADC 980 CITY OF ARLINGTON I D04 236 1 A 238 N OLYMPIC AVE 04357 Seq ARLINGTON WA 98M-1 OLYMPIC SG LLC 12 stal I of I C/O BILL STEWARD ID 0.49 4820 FOWLER AVE 1000 EVERETT WA 98203-3214 r Ill t m e-ot L� 5� , .0+y Make- Moc1 e,1 ` 3 C o m�c�( ine.�nk' J hn lUooS-- 38182yy-Zp1b _ C w +�h 2 dr�'1�n b oa.Yc1►s ) .,---- p►EIZ32N Z5Fv� <atof- (LeCNGAeS 1r L4 - E r^p10 ye-'C J$+D y C C f eskvvp ry-\ - 1 5 � r 1 7 be y-e.c1 C-i o o,,15 A vz pl,,, `� FIDE n<TIrrJ" 1 °oh -- �- ti0 o\j v%1 C-u n u 06 J- - -c�,v-tc`M X��. = a- — CACY 01c,rncm� — 1PM-20 eoa+-tea Me;Vc.\ oo c� ve.�n�- �. i�e1 �.x yZj HR-HPS`� p W o C IL A-�ble_ _ )oMr►gao5f co JNQ10 w c)�IL - -•b �- �, She e1r, ------'�Ls �.,�_ —I Lo�d'n��@•�'�"- `UC��.�� �j f��,t',�.�`l1 —� ......_._.' 1 1C�.o. (n�c�h �ES�r�� �o;w.�na�r+'�"' �ysE>Lz� 2 Pastry and cookie Sample Menu Chaotic Bakery Nicole Hinton 425.318.9954 Pastries • Cinnamon Roll $4.00 • Mini Pavlova $4.25 • Eclair $4.00 • Gourmet Brownie $3.50 • Croissant $3.00 • Specialty Croissant $4.00 Tarts • Lemon $4.75 • Seasonal $4.75 • Chocolate $4.75 • Mascarpone cheese $4.75 • Apple $4.75 Cookies • Drop cookies $2.75 • Gourmet Drop $3.25 • Decorated sugar starting at$3.50 • Ice Cream sandwich $7.00/Gourmet$8.00 Cake by the slice • Seasonal $3.75 • Frasier $4.50 • Cheese $4.25 • Daily $4.00 Whole Cakes • Seasonal 6"$35/8"$45 • Daily 6"$30/8"$40 Cupcakes • Seasonal $3.25 • Daily $3.00 • Premium $3.75 (1571 SNOHOMISH HEALTH DISTRICT WWW.SNOHD.ORG Environmental Health Division March 2, 2020 Nicole Hinton Project: New Food Service Establishment Subject: Chaotic Bakery Address: 119 Olympic Ave N, Arlington, WA 98223 Dear Nicole After reviewing your plans with the Rules and Regulations of the State Board of Health, and with the policies of the Snohomish Health District, your plans for Chaotic Bakery have been approved. The approval was based upon the plans, menu, and food flows submitted 12/23/2020 and 3/2/2020. Any changes to the plans, menu, and food flows without preapproval from the Health District will void this approval. A preoperational inspection is required prior to operating permit issuance and approval to open for business. At the time of inspection the construction of the food service establishment must be complete and all equipment must be in place and in proper operating condition. Incomplete construction or equipment operation will result in a $195.00 re-inspection fee. Contact the Food Program office a minimum of one week in advance to schedule an appointment for the preoperational inspection. Please review the following requirements and conditions of operation before scheduling: 1. If during routine inspections it is found that the current amount of refrigeration in inadequate for the refrigerated storage needs of the facility then the number of menu items must be reduced to a level acceptable for the facility's amount of refrigeration. The menu item reduction will remain in effect until such time as additional refrigeration is installed and approved by the Snohomish Health District. 2. No food storage or preparation is allowed in the establishment prior to the preoperational inspection and approval to open for business. 3. This facility lacks a food preparation sink. No washing or rinsing of fruit or produce will be allowed without the installation of a properly sized food preparation sink. All fruit and produce must be obtained pre-washed from the supplier. Please note that some fruits and produce are currently not available pre-washed. 4. Three-compartment sinks must have rounded corners and integral drainboards at both ends. The drainboards of the three compartment sink must be sloped to the basins. The basins of the three- compartment sink must be large enough to fit the largest item needing to be washed. 5. All food service equipment, both new and used, must be listed by the National Sanitation Foundation (NSF) or equivalent for its intended use. 6. Plumbing must meet state and local codes. 7. The ventilation system shall be installed and operated to meet applicable building, mechanical, and fire codes. After you have passed your preoperational inspection, the annual operating permit application and all fees must be received by Snohomish Health District prior to opening for business. This facility will be classified as a medium risk food establishment with 0-50 seats. 3020 Rucker Avenue, Suite 104 0 Everett, WA 98201-3900 ■ tel: 425.339.5250 0 fax: 425.339.5254 Your application for a food service establishment permit from the Snohomish Health District may be approved during this inspection. However, it is the responsibility of the food service establishment operator/owner to obtain all necessary permits and approvals from all applicable agencies. Operating the establishment without required permits or approvals may subject the operator/owner to enforcement action by the appropriate agency. Changes or additions to the approved plans or equipment require pre-approval from the Snohomish Health District prior to implementation of the changes. A copy of the Snohomish Health District Appeals procedure is available upon request. An administrative appeal must be initiated with 21 days from the date of this email. Please contact me if you have any questions. Sincerely, Kevin Chung Environmental Health Specialist Food Establishment Plan Review 425.339.8748 kchung snohd.org cc: Brent French, Snohomish Health District City of Arlington Building Department 3020 Rucker Avenue, Suite 104 ■ Everett, WA 98201-3900 ■ fel: 425.339.5250 ■ fax: 425.339.5254 Account 9- 4 68' SNOHOMISH 1:48,,n HEALTH DISTRICT WWW.SNOHD.ORG "fuff"I pnid- 740-1030 _ General Food Plan Review Application Application must be completed in full and submitted with fee and the items listed for processing: Reviewed by EHS Initials $740(PE 5672)General Plan Review New food service establishment El $1110(PE 56AK)General Plan Review Expedited Expedited New food service establishment Plan Review&Pre- Operational Inspection Fee _E1 $195(PE 5670)Limited Grocery Plan Review New Limited Grocery,Tap Room I Tasting Room [3 $292.50(PE 56AJ)Limited Grocery Plan Review Expediter Plan Review&Pre-Operation Inspection Fee El $740 Base fee glus$195 for each add'i permit New multiple permit food service establishment. Plan Review&Pre- (RE 5676&PE 5675) - Operational Inspection Fee El $1110 Multiple Permit Facility General Plan Expedited New multiple permit food service establishment Plan Review Expedited plus$196 for each addl Review&Pre-Operational Inspection Fee permit(PE 56AL&PE 5675) El $390(PE 5642)Change of Ownership Plan Change of ownership conditional operating permit. Includes Review PreoPening,Inspection. El $195(PE 5685)Alteration to Existing Alteration to existing food service establishment or revision of approved — Establishment or Revision of Approved Plan plan. Includes Pre-Operational Inspection. El $195(Pff 5677)Consultation Fee Plan review consultation On andtor off site) El $390 Lff 5482!Variance Plus lab fees Variance with HACCP—when required by WAC for menu items _7 i-E6TABIASHMENT INFQRMAT Q_N Name: 0-V%(_ Name: e` Site Address: I k 9 O' 1.1"Plic- Mailinq Address: I k ,A 0 kA fyi 1.) CIU: A-f ZIP:9 7 State:ply, PV ZIP: V6 -)Nv,( S %;\J 1 Name: t-1 \ c-aa— "t'tA rN Phone: Cl Address: E-mail Address: ci!y.: &S. State: \"j Zie: Name: Phone: Address: E-mail Address: CitX: State: Zi . Type of Food Service Establishment: . Local Building Inspection Agency: Cl'T'' n Water District: CA.JcA Water S11upply(check one e Well ubllc . Sewer District: Sewage Disposal(check one): IR,Sewer El Onsite Sewage System Inspection is based upon requirements 64'WAC 246-215;Rules&Regulations of the State Board of Health for Food Service Sanitation. Other agency approvals requisite to your operation may include County or City Planning,Building,Plumbing and Fire Departments, Water and Sewer Utilities. Signature of the owner or an officer of the legal ownership affirms the accuracy of the information provided in this application and that the permitted facilitytwill be operated in compliance with the rules of the Washington State Food Code. Signature, Date: 17 Print Name: C_ \A"A-�U-\r\ Environmental Health Division i;rso 3020 Rucker Avenue,Suite 104 E Everett,WA 98201-3900 0 fax:425.339.5254 N tel:425.339,5250 �+ SNOHOMISH HEALTH DISTRICT New Restaurant Plan Review Checklist W W W.SNOHD.ORG Facility name: Cr `o' O C� 1L�Cn\ -±2kA This checklist will help you prepare a complete plan review packet. Submit the completed plan review packet and checklist with the required application fee. Incomplete plan review packets will not be accepted. Make a copy of this plan review packet for your records prior to submittal. Plan review fees are non-refundable. ITEM - - DESCRIPTION -- - - Office - Uae Ong intake 1 Application Provide complete Food Plan Review application. 2 Water and Provide proof that the facility is connected to an approved water and sewer or ❑ sewer septic system. adequacy 3 Plan review Provide complete Plan Review Questionnaire form. questionnaire 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%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 Provide the materials used for all floors,walls,ceilings,counters,and cabinets. Ln schedule 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. Food Provide a description of how all menu items will be prepared. preparation steps j 10 Waste disposal Provide complete Waste Disposal form. I 11 Supplemental Provide complete Supplemental Question form(s)if applicable. questions (catering and food processing) 12 Fee T Include application fee. I understand I cannot open this food establishment until I have received written approval from this program, obtained all annual operating7pe;rts and have en inspected and approved by all applicable city, county and state agencies. Signature/Title Date r♦ I" nvl <�hlfshmauti'IanF2crvirrn�:;��_.t�IJs£ P:31 Environmental Health Division 3020 Rucker Avenue,Suite 104 ■ Everett,WA 98201-3900 0 fax:425.339.5254 IN tel:425.339.5250 SNOHOMISH HEALTH DISTRICT W W W.SNOHD.ORG Water and Sewer Adequacy/Food & Community Safety Facility name: C,)Y 1 (A 0Vt C- 4 l CA 1�- E'�V-A Site address: " cA C_ NQ C'_ N City: Imo( State:y4 A ZIP:c1 22 Parcel number: —Proposed number of seats: Contact name: N V cow n V-\ Phone: ,C6 `kC-A w�^ Email: Ch0'0)C.Cooy-le %`Fax: ,VNew construction ll Remodel/Alteration ®Expansion of existing restaurant X'es ©No Is the facility connected to a septic system? Wles p No Are public restrooms available? �Vles p No Is a grease trap required by sewer district or building department? Describe the proposed project: +o )in u i A c, kL A-C.)rN� 0r' , Sewage system`ewer bill or availability letter attached ❑Below completed by official 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 aboveabove address. System official: Phone: �`7l U d'� '1 Z Date: Water system .50ater bill or availability letter attached ❑ Below completed by official This section should be completed by a Public Water System Official, if a water bill or availability letter is not provided. Name of system: . _ State ID number: The above facility is connected ❑ has applied The above system will provide service to the facility listed at the103 above address. System official: Phone: �Ld I Z 1 Date: Food Estat!li0iirien Ulan Revicvvi:ltf(Nist_06 �-31(81K Environmental Health Division 3020 Rucker Avenue, Suite 104 ■ Everett,WA 98201-3900 0 fax:425.339.5254 ■ tel:425,339.5250 4XQSNOHOM1SH HEALTH DISTRICT Plan Review Questionnaire WWW.SNOHD.ORG Facility Name: C_�1.C7, 0\A C 1. Provide a description (the scope) of your project. e 1C t ne.. Y+�1 A<r-(J Y-r^-V\v\ 2. How many meals do you anticipate serving per day? V ' 3. How many times per week do you anticipate delivery of food? �-►,n�e 4. How many times per week do you anticipate delivery of dry goods? 5. ❑Yes�ECNo Will you offer catering? If yes, complete the catering questionnaire. 6. ❑ Yes Rio Will you offer off-site food delivery? 7. ❑ Yes�kNo Will alcoholic beverages be served?(include on menu) B. ❑ Yes Flo Is there customer seating inside the facility? How many seats are in the facility, including the bar and lounge? 9. ❑ Yes�Aio Is there customer seating outside the facility? How many seats are outside? 10. ❑ Yes ❑ No �M/A If you have customer seating, is your restroom accessible to customers without passing through food preparation,food storage and/or scullery areas? 11. ❑ YesANo Do you have to go outside to access any walk-in refrigeration/freezers,food storage, equipment, and cooking or preparation areas?All locations must be clearly marked on floor plans. 12. Where will chemicals such as cleaning products be stored? O fA ei e4— co►n IL-s 13. Where will employee belongings be stored? t r , e)t; a c>% c,pdi"<5easEJEi�l3rr��!r�Yr�lt�tirdr;�i<atirrf;?Ee;��Es,sEnraiEca„��:N,.�3ti 7p�`r rtE� Environmental Health Division 3020 Rucker Avenue,Suite 104■ Everett, WA 98201-3900■ fax;425.339.5254 0 tel:425.339.5250 14) ❑ No Is all lighting above food preparation, storage and service areas shatterproof or covered? (Required) 15. ❑ Yes?"No Will any food be self-service? If yes, list foods and how you will prevent contamination: 16. es ❑ No Are all food and single-service items protected from customer contamination by a sneeze guard?This includes self-service condiment bars, salad bars, buffet lines, espresso counters and all other food preparation areas. 17/t&es ❑ No Are handwash sinks located at all cook lines, food preparation and service areas, and dishwashing areas? 18*Yes ❑ No Is a 3-compartment sink with attached drainboards on both sides provided? (Required) 19.Wes ❑ No Is each basin of the 3-compartment sink large enough to submerge and wash all equipment? 20'.'?&es ❑ No Do all sinks, including 3-compartment sinks, and food preparation sinks have basins with rounded corners?(Required) 21` Yes ❑ No Can you completely fill two compartments of the 3-compartment sink with hot water and vide hot water at all handwash sinks without the temperature dropping below 100°F? (Required) 24 s ❑ No; A Are indirect drains (i.e. air gap) provided for all food preparation sinks, Ohwashers, ice machines, soda dispensers, steam tables,woks, dipper wells, espresso machines, beer tap drip trays, walk-in refrigeration/freezers, and all equipment in which food or food contact equipment is placed?(Buckets are not allowed) 23. ❑Yes'P No Does your menu include fresh fruit and vegetable items, such as lemons, limes, onions, tomatoes, potatoes, lettuce or berries? 24. ❑Yes ❑ No JN/A if your menu includes fresh fruit and vegetable items, is an indirectly drained food preparation sink with an integral drainboard provided? (Required) 25. ❑ Yes No Will you prepare, rinse or thaw under running water, raw meat, poultry, and or seafood? If yes, list: 26. ❑ Yes ❑ NoN!A if raw meat, poultry, or seafood are prepared, rinsed or thawed under running water, is a se and indirectly drained food preparation sink with an integral drainboard provided? (Required. Sinks with multiple compartments may not be used for both produce and raw meat prep.) c3ndC,atat li I�rvrknP�I,arfl tvira�rClus:;Yic�nrzair�„f_E'i,.06 N0 _;dip Environmental Health Division 3020 Rucker Avenue, Suite 104 ■ Everett,WA 98201-3900 0 fax:425.339.5254 0 tel: 425.339.5250 27.1�kYes ❑ No Is at least 19' of separation or proper barriers 16"tall provided between all food preparation sinks and any source of contamination? 28-A Yes ❑ No Is at least 16" of separation or proper barriers provided between all produce preparation sinks and raw meat, poultry, and or seafood? 29.5]Yes ❑ No Are 16"high splash guards installed between all sinks that are less than 16"apart? 30 // Yes ❑ No Are soap and paper towel dispensers installed inside the splash guard area at all handwash sink locations? 31.;4 Yes ❑ No Are all handwash sink basins at least 10" long by 10"wide and 5"deep? (Required) 32AYes ❑ No Do you have a designated mop sink?(Required) 33.ZYes ❑ No Is the mop sink located so food and equipment are not contaminated when used? 34. ❑ Yes)tA;No Does the mop sink have a vacuum breaker installed? 35. ❑ Yes Po Will a chemical dispensing system be installed at the mop sink? 36. ❑ Yes ❑ No AQN/A If a soda fountain system is used, is a reduced pressure backflow assembly (RPBA) Installed and tested? 37. ❑Yes ❑ No �U/A If a soda fountain system is used, are all pipes and fittings used downstream of the reduced pressure backflow assembly(RPBA) non-corrodible? (copper or brass are prohibited) 38.�,Yes ❑ No Is all equipment commercial grade, NSF certified or equivalent? (Required) 39. ❑ Yes No Will any food be stored or prepared at another location? If yes, list name and address where fooa will be stored or prepared: 40. ❑ Yes11No Will any food be cooked or hot held unattended (i.e. overnight or more than 2 hours of unattended cooking)? If yes, the questionnaire for cooked or unattended food must be completed. 41. ❑Yes 1 No Will there be any cooking or food preparation outside the establishment?All locations must b clearly marked on floor plans. 42. ❑ Yes � o Will any food of animal origin be undercooked at the customer's request, such as steaks, eggs, 6r hamburger? If yes, list: 1;'c;unit':�t;abliz.l3rrtantPl�� ribyl,7:(lurl:stlnnnmt� rt�_Ur .7-Q1Y AI; Environmental Health Division 3020 Rucker Avenue,Suite 104 0 Everett, WA 98201-3900 0 fax:425.339.5254 0 tel:425.339.5250 43.0 Yes to Will any fish or seafood be served raw or undercooked? If yes, list: 44. ❑Yes ❑ No id)N/A If fish or seafood will be served raw or undercooked, is proper parasite destruction do umentation submitted? 45. ❑Yes r No Will any menu items include wild mushrooms? If yes, the wild mushroom questionnaire must be completed. 46. ❑ Yes Oi No Will any food be smoked as a method of food preservation rather than flavor enhan ement? (Used to preserve or change a food so it no longer requires refrigeration) If yes, you must submit the food preparation steps for all the smoked foods along with laboratory documentation of shelf stability for each food item. 47. ❑ Yes o Will any food be cured? If yes, the food preparation steps for all the cured foods must be submitted. 48. ❑ Yes'pNo Will any food additives be used to preserve or change a food so it no longer needs to be refrigerated? If yes, the food preparation steps for all these foods along with laboratory documentation of shelf stability must be submitted for each food item. 49. ❑ Yes/Ls,No Willa display tank be used for molluscan shellfish, such as oysters or clams? If yes, submit additional information as noted in the Molluscan Shellfish Tank questionnaire. 50. ❑ Yes 0,'No Will custom processing of animals be offered for a customer's personal use as food (i.e. deer) and not for sale or service in a food establishment? If yes, submit the food preparation steps including how custom processed foods will be kept separated from all other foods during receiving, processing, storage and handling. 51. ❑Yes 1ANo Will any food be grown specifically for sale or service in the food establishment such as sprouts? If yes, the growing and food preparation steps for all these food items must be submitted. 52. ❑ YesNo Will any food be vacuum packaged or reduced oxygen packaged? If yes, submit addition I information as noted in the Vacuum Packaging-Reduced Oxygen Packaging questionnaire. 53. ❑ Yes o Will any food be cook-chill or sous vide ? If yes, submit additional information as noted in the cook-chill or sous vide questionnaire. If you answered yes to questions 44-51, include the proper food preparation process descriptions and variance request. 'zEadt;sFc3k�11911tE1�'iif�alamf;�vicwe�EE�:�:;kPs,r�aEatra_arll_UIi�2A1'1.,t1f�1 Environmental Health Division 3020 Rucker Avenue,Suite 104 0 Everett, WA 98201-3900 ■ fax:425.339.5254 0 tel:425.339.5250 1 00 0 0 0 C) coo o 00 00 mom _ 00 0 00 00 00 0 OC-) y g 00 O 0 (- IL - ILL � � J rwwiw lL B w E o so s lop g o� 1 1a y F �ie� 'a s?L LI 41 EE flits [ _ oo QQ 0 �y V . Environmental Health Division 3020 Rucker Avenue,Suite 104 9 Everett,WA 98201-3900 0 fax:425.339.5254 0 tel:425.339.5250 SNOHOMISH HEALTH DISTRICT Equipment List IMW WWW.SNOHD.ORG Facility name: List all food service equipment, including make and model numbers. Examples include, but are not limited to, refrigerators, sinks, stoves, ovens, steam tables, blenders, ice machines,ventilation hoods, and all countertop appliances. If make and model number cannot be found, a picture of the equipment is required. The item numbers on this list must be the same as the item numbers for the equipment on the floor plan. All equipment ID numbers must correspond to location on floor plan. Equipment must be commercial grade and meet American National Standards Institutes(ANSI) standard (NSF, ETL or UL Sanitation listed). Only one item per line. Sample Equipment List ID # Kind of equipment Make Model# 1 Refrig�o.-* -in. . i1 �1 �� 1�� c `+ . an � a 18b�1 �si�' � r�' r'- - f 't A .. .. o:1t�S[�. -a> l�JltlM. #m e equipment list is included on floor plan. 5- —Z Aicr\CU L'L 6-- f> v 1 ' c� f �'(� ���►��t�r c�.,-ems 16-1 F(c_10 o E) Environmental Health Division 3020 Rucker Avenue,Suite 104 0 Everett,WA 98201-3900 0 fax: 425.339.5254 ■ tel:425.339.5250 Please add a second page if needed. ff \yam CAL VeAh'lx—, `J'���1'�-c,y-4 W o �0"^ T )aria 1 U C-z f,rer 51ry-, on e- M ox ICArn►7l�u � u�•.c��. �i o\ - �� Nc,,nA s � 4V- �3 Environmental Health Division 3020 Rucker Avenue,Suite 104 0 Everett,WA 98201-3900■ fax:425.339.5254 ■ tel:425.339.5250 SNOHOMISH HEALTH DISTRICT WWW.SNOHD.ORG Finish Schedule Facility name: Provide the materials used for all floors,walls,caving and ceilings. • All bare wood surfaces (doors, trim, counters, shelves, cabinets, etc.)must be painted or sealed. • Floors must be constructed of light colored, smooth, easily cleanable, non-absorbent material. Expansion joints, seams, saw cuts and the like in concrete floors in all areas, including customer seating areas, must be filled and sealed so as to provide a smooth and cleanable surface. • Coving must be installed at all wall/floor junctions. • Walls must be constructed of light colored, smooth, easily cleanable, non-absorbent materials. Provide Fiber Reinforced Plastic(FRP), laminate plastic,tile, or similar waterproof material on wall surfaces behind sinks, dishwashers, food preparation areas, and areas exposed to moisture. • Ceilings above the kitchen, lounge, wait and service areas must be constructed of light colored, smooth, easily cleanable, non-absorbent materials. Unsealed and or perforated acoustical ceiling tiles are not allowed. Vinyl covered ceiling tiles such as vinyl rock or other washable surfaces are allowed. • All lighting over food preparation, handling and storage areas must have covers or shatterproof bulbs. Sample finish schedule Kitcheh vinyl tile 6"rubber base FRP painted gypsum board laminate Wait area vinyl the 4"rubber base painted gypsum board vinyl rock laminate Loup"a n sealed concrete 4"rubber base varnished wood Armstrong VL.tiles granite carpet 4"rubber base Painted gy psum board painted gy psum board n/a Bathrooms. ceramic tile ceramic the painted gypsum board I painted gypsum board laminate IsKigllhT Refrf erators and d story e:stainless steel wire shelves;li uorstora e:varnished wood tlrt Bar lights are shatteiproof All kitchen lights have covers. F'nish schedule Included on floor plans o `-- V l rt��<' t-� C71,[t4b --c b! `L Cl �,r.,n�v.►- 1�1nF'C�UY V TI\e �J�cbly r o{e< ``3.... 1: ��l.urv► T h/cuc� 10 �✓� '1 'A e'g65eA Wove LaurFge J/ NIA a r V�wSl shaC+ �2 �r-S lv�s st��l 1- �GSE C oct'V' o"V-0-- Ortc\ cow-rye iVs�uc1F..Gy8x3alf:�iir;�ai�P.r'fanf�ovi�wChc�:scl..l��_f:ti_..I)Yz,;icr�?T.. :f.fe; Environmental Health Division 3020 Rucker Avenue, Suite 104■ Everett, WA 98201-3900 0 fax:425.339.5254■ tel:425.339.5250 SNOHOMISH HEALTH DISTRICT WWWSNOHC).ORG Menu Sample Facility name CNN L Qk L Provide copies of your menus. Include all food and beverages you will serve. If the facility is a grocery store serving only fruits, vegetables or commercially prepackaged food, a list of goods sold may be submitted in place of the menu. Be sure to include specials and seasonal items. Only food and beverages listed may be served. Submit copies of all breakfast, dinner, lunch, bar/lounge, happy hour, kids, catering, and online menus,fresh sheets,table tops or menu boards. If a menu board will be used, provide photographs of the menu showing all food and beverages listed. All menu items must be readable in photographs. Menu, food preparation steps, and the mode of operation may be restricted to protect public health (WAC 426- 215). A consumer advisory is required for all food of animal origin that is offered raw, undercooked or cooked to the customer's specification. Be sure all menu items requiring a consumer advisory are clearly identified and remind the patron that consuming these foods may result in foodborne illness. Consumer Advisory information may be found at Washington State Department of Health under Code Clarifications. Sample menu AAA #1 Drive In Breakfast Salads Pancakes ........................................... $2.00 Mixed greens.......................................$3.00 Eggs*, hash browns, bacon, toast...... $3.00 Romaine..............................................$3.00 Oatmeal.............................................. $2.00 Caesar*...............................................$3.00 Lunch Beverages Ham sandwich.................................... $3.00 Fountain beverages Phosoup*........................................... $3.00 Large...................................................$3.00 Rib eye steak*...................................$10.00 Medium...............................................$2.00 Dinner Small...................................................$1,00 Prime rib*...........................................$10.00 Coffee.................................................$1.00 Shrimp pasta.....................................$10.00 Tea......................................................$1.00 Deluxe cheeseburger*.......................$10.00 Chicken salad....................................$10.00 *These menu items are served raw, undercooked or cooked to your specification. Consuming raw or undercooked food may increase your risk of foodborne illness. 3ii:rw`�;.�ri;g�l<�_C:i�_tiiiy1.;1•�E..i;':;c: Environmental Health Division 3020 Rucker Avenue,Suite 104 9 Everett, WA 98201-3900 0 fax:425.339.5254 0 tel:425.339.5250 SNOHOMISH HEALTH DISTRICT Food Sources W W W.SNOHD.ORG n Facility name: C" List all food and beverage suppliers you use. Please check the boxes of the common suppliers you use and add the name and phone number of any of your suppliers that are not already listed. This list is provided for informational purposes only and for the convenience of the user. This should not be taken as an endorsement by the Snohomish Health District. This is not a complete list of available suppliers. Look in the Yellow Pages or similar references for additional suppliers. Name of supplier Phone number ❑ ,:.Q`tyds Caffiee �.. UA.545,4Q77 Cash N Carry(Everett) 425 339.2628 1u ChgCl ' 20.682514�2 . ❑ Coke 800.647.2653 gosc ..(; ee - . s � 71745i.- t 99 ostco Business Center(Lynnwood) 425.640.7700 ❑ Franz Bakery 206.682.2244 ^� ❑ Restaurant Depot (Woodinville) 425.483.5600 (� �^c K. *-.�.�,,r�.< l�'a`,- 6' 001 lj'ff'��Ci ti;••,-`y 1: ❑ Sa m's,l�lub.. ., ,: ..i ; rvs �d ICC 17Ak:,FIJ4%•x. • 4:f ❑ Sunfood Trading 206.682.8823 syTU _'*'T.''.<i[v"'.,:;t '4^ '1,R[YYu54i ,�•''.1tiKfFTiF. y::.3sYr 1 + �. .a!{Yo� � 1-1 N 1F)G6�r:.?�L',4�11w'�lil1(DTf��'I�71I'ZtIVfG,V"C3d}E,i:�Z3 i?i CG;+,_F'.I'I...(11j..aQI I._�)�1 . Environmental Health Division 3020 Rucker Avenue,Suite 104 ■ Everett,WA 98201-3900 0 fox:425.339.5254 0 tel:425.339.5250 SNOI�OMISH HALT DISTRICT Food Preparation Steps WWW.sNOHb.oRG Provide the food preparation steps for all menu items. Include how each menu item is obtained, stored, prepared, cooked, cooled and kept hot before serving. Menu items that are prepared in an identical way may be grouped together. Menu, food preparation steps, and the mode of operation may be restricted to protect public health (WAC 426-215). Examples: BBQ beef/pork—beef and pork are delivered frozen and stored in the walk-in refrigerator to thaw. After the beef and pork are thawed,they are marinated in our special sauce in the walk-in refrigerator overnight. Meats are then cooked on the smoker. After smoking, the beef and pork are shredded and mixed with our BBQ sauce and cooled in hotel pans at 2"food depth in the walk-in refrigerator. After meats are cooled to 41 OF, they are covered with plastic wrap. Meats are reheated in the steamer as needed and kept in the front area steam table until served. Leftover items are cooled uncovered in the walk-in refrigerator at 2" food depth. All hamburgers—patties are purchased frozen. Frozen patties are placed on grill once ordered. Hamburger patties are not cooked in advance. Pho soup—beef bones are delivered and stored in the walk-in refrigerator. The beef bones are placed into a large pot, and water is added. The bones and water are brought to a boil and vegetables and spices are added. After soup is cooked half of the broth is held hot on the range at above 1350F and the remainder is cooled to 41 OF uncovered in the walk-in refrigerator at 2"food depth. The remaining pho soup is reheated to over 165'F the next day before use. Chicken salad—raw chicken is purchased frozen and thawed in the walk-in refrigerator. Chicken is marinated overnight in the walk-in refrigerator. Chicken is cooked on char-broiler, cut into small pieces and placed on sheet pan at 2"food depth to cool in the walk-in refrigerator. After chicken has cooled to 41°F,the chicken is portioned and wrapped. Portioned chicken is kept in the preparation refrigerator until ordered. Chicken is mixed with greens and salad toppings per order.All salad greens are rinsed each morning in the food preparation sink and stored in the preparation refrigerator. Ham/turkey/roast beef sandwiches—ham, turkey and roast beef are purchased pre-cooked. Meat is sliced daily, portioned, and placed in the preparation refrigerator.All fruits and vegetables are rinsed each morning in the food preparation sink and stored in the preparation refrigerator. Sandwiches are made to order and served cold or heated on panini grill. Shrimp pasta—shrimp is purchased pre-cooked and frozen. Shrimp is thawed in the walk-in refrigerator. Pasta is par-cooked on stove and cooled at 2"food depth uncovered in the walk-in refrigerator. Once cooled to 41 OF, the shrimp and pasta are portioned, bagged and stored in the preparation refrigerator.When ordered by customer, portioned pasta and shrimp are sauteed on stove-top. F000r,-totlhfif,h1"ontF,lanRrvlaysFoodi4,ropsto}ie_rz El! xot't.par. Environmental Health Division 3020 Rucker Avenue,Suite 104 ■ Everett,WA 98201-3900 0 fax:425.339.5254■ tel:425.339.5250 t SNOHOMISH HEALTH DISTRICT WWW.SNOHD.ORG Waste Disposal Facility name: C." Garbage Name of the company: l/��`7� G r�C" a 2.YAAAM- Size and type of container: !aytw a A Frequency of pick-up: a�%Ck__ Cj' u'j x Location of container: CxCN--- C) Distance from building: Waste oil I Name of the company: I A Size and type of container: Frequency of pick-up: Location of container: Distance from building: Recycling 1 Name of the company: eyv\A-(-N T Size and type of container: s• cn,rA c,\ c Frequency of pick-up: t-)V\C..__ CA, Location of container: G�J Distance from building: } Pey!wC'h(T`- 1.1A 1'11 0,11_0IIn Environmental Health Division 3020 Rucker Avenue,Suite 104 ■ Everett,WA 98201-3900 ■fax:425.339.5254■ tel:425.339.5250 ITZ SNOHOMISH 4 HEALTH DISTRICT iy wwwsN01D.0R0 Catering Questions Facility name Y VCx,CL t~ --E'-� This application is only for offsite catering. This includes set-up or service of food items outside of the permitted food establishment. Please answer the following questions. Attach numbered responses if you need additional space. Check all the types of catering you will provide. ❑ Self-service buffet line ❑ Served buffet line(served by catering staff) ❑ Table Service 1. 0 Yes ❑ No Do you have a valid restaurant permit in Snohomish County? If no, provide the name, address and contact person of the approved establishment where food will be prepared, and a signed commissary use letter. (Note that commissaries must be within Snohomish County) Approved establishment name: Address: Contact person: 2. The maximum number of catered meals served daily is . (The approved number will be included on your permit. This is the total number of customers you may serve in one day.) 3. The'volume of food to be stored along with anticipated number of events to be catered per week and anticipated number of meals to be served must be submitted. Include whether or not more than one event may be catered on any day. 4. Provide a detailed catering menu that lists all food and beverages that may be catered. The catering menu must be separate from the restaurant menu. (Please attach.) 5. How will beverages be served? ��iTl t?i'f Yl f? E�lff:•i�l(1P5!i ��"I � �_�i ��� �:�.i 1 Environmental Health Division 3020 Rucker Avenue, Suite 104 ■ Everett,WA 98201-3900 0 fax:425.339.5254 0 tel:425.339.5250 6. Will any beer, wine or mixed drinks from portable bars be served? If yes, provide specification sheets for portable bars and details of handwashing facilities. 7. Will any food of animal origin(i.e. meat, seafood, eggs) be offered raw, undercooked or cooked to customer specification? ❑INo, we do not offer raw or undercooked food items. ❑ Yes. I will provide a Consumer Advisory Warning for any menu item that will be served raw or undercooked. This includes raw meat, shellfish, such as oysters on a half shell, Caesar salad (dressing made with raw egg), sushi, steak tartare, eggs over easy, steaks cooked to order, etc. A Consumer Advisory Warning will be present on the catering menu and at the serving area. An example of the buffet line Consumer Advisory Warning, such as a table tent or placard, has been provided. (Please attach with menu.) 8. How often is food delivered to your establishment? Provide the quantity of food per delivery. 9. List any food that will be cooked at a catered event site: 10. List any food that will be prepared at a catered event site: ciovoria 5111 2 Environmental Health Division 3020 Rucker Avenue, Suite 104■ Everett,WA 98201-3900■fax:425.339.5254 0 tel:425.339.5250 11. Provide details of how food will be kept hot and kept cold before and during service at the event. 12. List what reheating equipment will be provided if hot food falls below 135OF: 13.A walk-in refrigerator is required for cooling. If any food will be cooled, is a walk-in refrigerator shown on the floor plans? ❑ Yes,walk in provided. The dimensions are ft by ft. ❑ No,we do not cool food. 14. List any food that will be cooled. Include any leftover hot food that will be saved or food that will be cooked, cooled and reheated later. 15. Describe your policy for what happens to leftover food items at the end of each catered event. 16. Leftover food items set out for service must be discarded. Food that has warmed or cooled into the temperature danger zone (41°F to 135°F)must be discarded. Please acknowledge by initialing here: — Calerins, om-Air"WZ IM 1'1,2 11P, slij 3 Environmental Health Division 3020 Rucker Avenue, Suite 104 0 Everett,WA 98201-3900 a fax:425.339.5254■tel:425.339.5250 17. Provide details of what equipment will be used to transport hot and cold food to catered functions. Provide equipment specification sheets and identify the quantity of each type of equipment that you will have. 18. Provide the year, make and model number of all vehicles used to transport food to catered events. Include a picture of the vehicle with the license plate number identified. Vehicle make: Vehicle model: Vehicle license plate: 19. How will utensils, plates, linens and other equipment be transported? 20.[1 Yes®No Will you provide dishes, utensils or glassware at catered events? If yes, how will they be cleaned? 21, If linens, utensils and plates are provided by another service, provide name of company and contact number. t"�star•in�; Ll�t<<r;+iem; t�l-f 'I a; t'I[s �.Fii 4 Environmental Health Division 3020 Rucker Avenue, Suite 104 0 Everett, WA 98201-3900 0 fax: 425.339.5254 ■tel:425.339.5250 22. Handwash sinks are required at all serving locations including beverage service areas. Restroom handwash sinks do not meet this requirement. Provide details of all temporary handwash stations you will use at remote sites.At least one temporary handwash station must be provided. 23.©Yes©No Will your handwash sink be stocked with soap, paper towels and warm water(between 100-120°F)? 24. Sneeze guards must protect any open food or condiments at the serving area. Provide dimension, elevation and material of sneeze guard protection for hot and cold entrees on the serving line. 25. What type of barriers will be used to prevent public access to the cooking/preparation/storage/service areas? 26. Provide a sample catering line showing how serving lines are set-up. Include location of handwash stations and sneeze guard protection for open food. (Please attach.) 27. 1 agree to provide Snohomish Health District a monthly catering schedule. Please acknowledge by initialing here: Provide the name, email and phone number of person who will supply the catering schedule: Name: Phone: Email: tat.=eirw f IA J 7 7 i 18 srii 5 Environmental Health Division 3020 Rucker Avenue, Suite 104 0 Everett,WA 98201-3900 0 fax:425.339.5254 0 tel:425.339.5250 Coffee Sample Menu Chaotic Bakery Nicole Hinton 425.318.9954 Coffee 80z 12oz 16oz • Mocha $4.00 $4.50 $5.00 • Espresso Single shot$1.50 Double shot$2.50 • Cappuccino $3.25 $3.75 $4.45 • Latte $3.25 $3.75 $4.25 • Breve $3.50 $4.00 $4.50 • Americano $3.00 $3.25 $3.50 • Chai Tea $3.25 $3.50 $3.75 • Hot Chocolate $2.50 $3.00 $3.50 • Hot Tea $2.00 $2.25 $2.50 o Extras ■ Flavored Syrup $0.50 • Honey $0.50 ■ Extra shot $1.00 Milk alternatives • Almond $0.50 • Soy $0.50 • Oat $0.50 Food Preparation steps Chaotic Bakery Nicole Hinton 425.318.9954 Sugar cookies/Drop cookies—Flour,white granulated sugar, brown sugar is purchased in 50 pound bags from Costco and stored on a dry good bin.All extracts are purchased at smart food services and stored on a dry good storage rack.All spices and Baking powders/sodas are stored in their original containers on a dry storage rack. Butter and eggs are purchased cold from Costco and once arrived at the bakery, placed immediately into the reach-in refrigerator to be stored at 41 degrees F.All Ingredients are mixed together in a commercial Stand mixer and portioned out into saran wrap and put into the Reach—in refrigerator to cool to 41 degrees F.once temperature is achieved, dough is rolled out on a floured surface,cookies are placed in a preheated commercial oven at 375 degrees F for 8 minutes and once out of the oven,they are placed on a cooling rack with a cover till they become cool enough to be placed in a refrigerated display case and held at 40 Degrees F. Ice Cream cookie Sandwiches-Flour,white granulated sugar, brown sugar is purchased in 50 pound bags from Costco and stored on a dry good bin.All extracts are purchased at smart food services and stored on a dry good storage rack.All spices and Baking powders/sodas are stored in their original containers on a dry storage rack. Butter and eggs are purchased cold from Costco and once arrived at the bakery, placed immediately into the reach-in refrigerator to be stored at 41 degrees F. Ice Cream is purchased pre-made from Costco,once transported to the Bakery, its then immediately place into the Commercial Drop in freezer and stored at 0 Degrees F.All Ingredients are mixed together in a commercial Stand mixer and portioned out into saran wrap and put into the Reach—in refrigerator to cool to 41 degrees F.once temperature is achieved,dough is rolled out on a floured surface, cookies are placed in a preheated commercial oven at 375 degrees F for 8 minutes and once out of the oven, they are placed on a cooling rack with a cover till they become cool enough to be placed in a refrigerated display case and held at 40 Degrees F. Once Ice Cream sandwich is ordered,cookies are pulled from case and ice cream is scooped to make the sandwich and served in a Parchment paper bag. Cinnamon Roll-Flour,white granulated sugar, brown sugar,and Powdered sugar is purchased in 50 pound bags from Costco and stored on a dry good bin.All extracts are purchased at smart food services and stored on a dry good storage rack.All spices and Baking powders/sodas are stored in their original containers on a dry storage rack. Butter and eggs are purchased cold from Costco and once arrived at the bakery, placed immediately into the reach-in refrigerator to be stored at 41 degrees F. Dry Active yeast is purchased from Business Costco and transported to the bakery and stored on the dry rack storage.Yeast is mixed with warm tap water and set aside uncovered to activate.All ingredients are mixed together in the mixer and the dough is kneaded on a floured surface. Dough is placed in a stainless steel bowl and covered with saran wrap and proofed for 2 hours at room temperature.Then dough is made into rolls and proofed once more on Drying rack covered in saran wrap. Rolls are placed into a preheated oven at 350 Degree's F.Once out of oven, rolls are placed on drying rack till cool and placed in the refrigerated display case and held at 41 Degrees F. Icing is made ahead of time and stored in the reach—in refrigerator. Mini Pavlova- Eggs are purchased from Costco and transported to the bakery and immediately placed in the reach-in refrigerator and stored at 41 Degrees F.All extracts are purchased at smart food services and stored on a dry good storage rack. All dry ingredients are purchased from business Costco and stored at room temperature on a dry goods storage rack. Bavarian cream and fruit curd is purchased premade from smart food service and store on the dry goods storage rack. All ingredients are mixed together in a stand mixer and placed on sheet pan and placed in a preheated oven at 225 degrees. Once out of the oven,they placed on cooling rack till room temperature and place in a dry goods display case. tclair-Flour,white granulated sugar, brown sugar is purchased in 50 pound bags from Costco and stored on a dry good bin.All extracts are purchased at smart food services and stored on a dry good storage rack. Bavarian cream,custards and fruit curds are purchased premade from smart food service and stored on a dry storage rack.All spices and Baking powders/sodas are stored in their original containers on a dry storage rack. Butter and eggs are purchased cold from Costco and once arrived at the bakery,placed immediately into the reach-in refrigerator to be stored at 41 degrees F. Butter is melted in a microwave and the rest of the ingredients are mixed by hand in a stainless steal bowl. Batter is piped onto a cookie sheet and baked at 350 degrees and cooled on a bakers rack. Once room temperature,custard is piped into eclair shell and glazed and placed into the refrigerated display case and stored at 41 degrees. Gourmet Brownie-Flour,white granulated sugar, brown sugar is purchased in 50 pound bags from Costco and stored on a dry good bin.All spices and Baking powders/sodas are stored in their original containers on a dry storage rack. Butter and eggs are purchased cold from Costco and once arrived at the bakery, placed immediately into the reach-in refrigerator to be stored at 41 degrees F, all ingredients are mixed in the stand mixer and put into baking pans and baked at 375 degrees.After baking, they are placed on cooling rack till room temperature then transported to either the dry case or the refrigerator. Croissant-Flour,white granulated sugar, brown sugar is purchased in 50 pound bags from Costco and stored on a dry good bin.All spices and Baking powders/sodas are stored in their original containers on a dry storage rack. Butter and eggs are purchased cold from Costco and once arrived at the bakery, placed immediately into the reach-in refrigerator to be stored at 41 degrees F.Dough ingredients are mixed in the stand mixer and wrapped in saran wrap and placed in the refrigerator overnight.The dough is then rolled out on a floured surface and rested again in the refrigerator.Once ready to bake,the dough is proofed in a covered dry rack and then placed in the oven at 350 degrees.Once done baking, they are placed on cooling rack and then transferred to dry display case. Specialty Croissant-Flour,white granulated sugar, brown sugar is purchased in 50 pound bags from Costco and stored on a dry good bin.All spices and Baking powders/sodas are stored in their original containers on a dry storage rack. Butter and eggs are purchased cold from Costco and once arrived at the bakery, placed immediately into the reach-in refrigerator to be stored at 41 degrees F. Dough ingredients are mixed in the stand mixer and wrapped in saran wrap and placed in the refrigerator overnight.The dough is then rolled out on a floured surface and chocolate is wrapped inside and then rested again in the refrigerator.Once ready to bake,the dough is proofed in a covered dry rack and then placed in the oven at 350 degrees. Once done baking,they are placed on cooling rack and then transferred to dry display case. Tarts-Flour,white granulated sugar, brown sugar is purchased in 50 pound bags from Costco and stored on a dry good bin.All spices and Baking powders/sodas are stored in their original containers on a dry storage rack. Butter and eggs are purchased cold from Costco and once arrived at the bakery, placed immediately into the reach-in refrigerator to be stored at 41 degrees F.Chocolates are purchased in bulk from amazon and delivered to the bakery then stored on a dry shelf.Tart shell dough is mixed in the stand mixer and rolled out and placed into tart shells and baked at 350 degrees and then cooled. Custards are piped into shells or chocolate ganache is made by warming chocolate and cream by microwave and piped into tart shells and then placed into refrigerated display case and stored at 41 degrees F. Frasier cake—Flour,white granulated sugar, brown sugar is purchased in 50 pound bags from Costco and stored on a dry good bin.All spices and Baking powders/sodas are stored in their original containers on a dry storage rack. Butter and eggs are purchased cold from Costco and once arrived at the bakery, placed immediately into the reach-in refrigerator to be stored at 41 degrees F.All sponge cake Ingredients are mixed in a stand mixer and poured into cake pans and baked at 350 degrees F.The cakes are placed on cooling racks while mousseline is prepared. Milk and butter are warmed in the microwave and then other ingredients are incorporated.The custard is set up in the refrigerator and piped on top of sponge cake with frozen strawberries cut and placed in between layers. Marzipan is rolled out on work surface and cut out and placed on top of cake.The cake is then place in the refrigerated display case and stored at 41 degrees F. Seasonal Cake—Flour,white granulated sugar, brown sugar is purchased in 50 pound bags from Costco and stored on a dry good bin. All spices and Baking powders/sodas are stored in their original containers on a dry storage rack. Butter and eggs are purchased cold from Costco and once arrived at the bakery, placed immediately into the reach-in refrigerator to be stored at 41 degrees F. Solid Chocolates and chips are purchased on amazon and delivered directly to the bakery and store on a dry shelf. Cake batter ingredients are all combined in the stand mixer and poured into cake pans and baked at 350 degrees F. once done,cakes are cooled on cooling rack till cool enough to wrap in saran wrap and placed in the reach in refrigerator. Buttercream in then mixed in the stand mixer and put into piping bags.Cake and buttercream are made into a cake and decorated and placed in the refrigerated display case and stored at 41 degrees F. Daily Cake—Flour,white granulated sugar, brown sugar is purchased in 50 pound bags from Costco and stored on a dry good bin.All spices and Baking powders/sodas are stored in their original containers on a dry storage rack. Butter and eggs are purchased cold from Costco and once arrived at the bakery, placed immediately into the reach-in refrigerator to be stored at 41 degrees F. Solid Chocolates and chips are purchased on amazon and delivered directly to the bakery and store on a dry shelf. Cake batter ingredients are all combined in the stand mixer and poured into cake pans and baked at 350 degrees F. once done,cakes are cooled on cooling rack till cool enough to wrap in saran wrap and placed in the reach in refrigerator. Buttercream in then mixed in the stand mixer and put into piping bags.Cake and buttercream are made into a cake and decorated and placed in the refrigerated display case and stored at 41 degrees F. Cupcakes—Flour,white granulated sugar, brown sugar is purchased in 50 pound bags from Costco and stored on a dry good bin. All spices and Baking powders/sodas are stored in their original containers on a dry storage rack. Butter and eggs are purchased cold from Costco and once arrived at the bakery, placed immediately into the reach-in refrigerator to be stored at 41 degrees F. Solid Chocolates and chips are purchased on amazon and delivered directly to the bakery and store on a dry shelf.cupcake batter ingredients are all combined in the stand mixer and poured into cupcake pans and baked at 350 degrees F.once done,cupcakes are cooled on cooling rack till cool enough to covered in saran wrap and placed in the reach in refrigerator. Buttercream in then mixed in the stand mixer and put into piping bags.Cupcakes are then decorated with buttercream and placed in the refrigerated display case and stored at 41 degrees F. Espresso— Coffee beans are purchased in bulk online and delivered directly to the bakery and stored on a dry shelf in its original container till ready for use.Coffee beans are placed into grinder hopper and ground once coffee is ordered.Ground coffee is placed into group head and tamped down and placed into the espresso machine and extracted. Espresso is then poured into appropriate cup with or without hot water from the espresso machine and served. Latte—Coffee beans are purchased in bulk online and delivered directly to the bakery and stored on a dry shelf in its original container till ready for use. Milks are purchased from Costco and transported directly to the bakery and stored in the reach in refrigerator at 41 degrees F.Coffee beans are placed into grinder hopper and ground once coffee is ordered. Ground coffee is placed into group head and tamped down and placed into the espresso machine and extracted. Milk is poured into designated milk pitcher and frothed with espresso machines steam wand to 160 degrees F.Espresso is then poured into appropriate cup with the heated milk and served. Tea— Tea is purchased from amazon and delivered directly to the bakery and stored on a dry shelf. Hot water is poured directly from the espresso machine into an appropriate cup and tea bag is placed into cup and served. r COMMERCIAL MECHANICAL APPLICATION Community&Economic Development City of Arlington• 18204 59th Ave NE•Arlington,WA 98223• Phone (360)403-3551 This application is for new,addition,altered or replaced mechanical installation and new or altered gas piping and must be accompanied by ELETRONIC FILES and TWO (2) SETS OF CONSTRUCTION DRAWINGS and CUT SHEETS and/or information outlined in the MECHANICAL SUBMITTAL REQUIREMENTS,if applicable. Type of Permit: C3 New Installation ❑ Addition ❑ Alteration ❑ Replaced ❑ Gas Piping Property Address. 119 north Olympic ave Project Valuation: 6300.00 Lot#: Parcel ID No.: Preferred Contact: 2 Owner O Contractor Project Description: Bakery Owner Name: Nicole Hinton Home No.: Email Address: Chaoticcookiebakery@gmail.com Cell No.: 4253189954 Mailing Address: 5226 257th st ne City, Arlington State: Wa Zip: 98223 Contractor Name. Xxxxx Office No.: Email Address: Xxxxxx Cell No.: Xxxxxxxxxx Mailing Address: Xxxxx City: Xxxx State: Xx Zip: Xxxxx L&I Contractor License Number: Xxxxxxxx Expiration Date: Xxxxxx • New gas piping requires a pressure test hooking to any appliance • Sediment traps(drips) are required on all gas lines • Gas lines are required to be supported/secured per IFGS,Section 415. • Proper Combustion air and venting required for all appliances • A shirt-off valve is required within 6 feet of all appliances Gas Piping Specification and complete Schematic PAGE 3 O Not Applicable O CSST O Brass O Other Proposed Piping Material: O Black Steel O Galvanized Steel Proposed Piping Size: O 1/2" O 5/8 O 3/4 1711 O 11/i" 1712 Inlet Pressure: Pressure Drop: Specific Gravity: I hereby certify that the above information is correct and that the construction on,and the occupancy and the use of the above described property will be in accordance with the laws,rules and regulation of the State of Washington. Nicole Hinton March 19, 2020 Signature Print Name Date FOR STAFF USE ONLY PERMIT# ACCEPTED BY: DATE STAMP REV2.2020 Pagel 43 MECHANICAL PERMIT FEES (per unit Type of Fixture No.of Units Cost per Unit Subtotal Additional Plan Review fees x $75.00 = $ 0 Air Cond Unit:5 100Btu i x $15.00 = $ 0 Air Cond.Unit>10OBtu h x $25.00 = $ 0 Air Cond.Unit>50OBtuAip x $50.00 = $ 0 Air Handling Units x $15.00 = $ 0 Base Mechanical Fee $25.00 $25.00 Boiler<10OBtu h>31i x $15.00 = $ 0 Boiler>1 million Btu/h<50hp x $25.00 = $ 0 Boiler>1.5 million]3tuAi<50lip x $50.00 = $ 0 Boiler>10OBtu 13-15h x $15.00 = $ 0 Boiler>50OBtu h 15-30lip x $25.00 = $ 0 Commercial Hoods-1ype I x $25.00 = $ Commercial Hoods-lype II x $50.00 = $ Diffusers x $15.00 = $ 0 Dryer Ducting x $15.00 = $ 0 Ductwork(drawings required) x $25.00 = $ Evaporative Coolers x $15.00 = $ Exhaust/Ventilation Fans x $15.00 = $ Fire lace Insert Stove x $15.00 = $ Forced Air Heat 15 100 Btu h x $15.00 = $ Forced Air Heat>100 Btu h x $25.00 = $ 0 Gas Clothes Dryer x $15.00 = $ 0 Gas Fired AC<_100 Btu Ai x $15.00 = $ 0 Gas Fired AC>100 Btu h x $25.00 = $ 0 Gas Fired AC> 500 Btu Ai x $50.00 = $ 0 Gas Pi in <_ 5 units x $15.00 = $ 0 Gas Piping> 5 units(plm<5 mits x $2.00 = $ 0 Heat Exchangers x 1 $15.00 = $ 0 Heat Pump-Condensing Unit x $25.00 = $ 0 Hot Water Heat Coils x $15.00 = $ 0 Miscellaneous Appliance-regulated by x $15.00 = $ 0 mechalucal code,not otherwise specified Pkg.Units<_100btu x $25.00 = $ 0 Pkg.Units>100btu x $50.00 = $ 0 Range/Cook to Gas Fired x $15.00 = $ 0 Refrigeration Unit<_10OBtt1 h x $15.00 = $ 0 Refrigeration Unit>10OBtt1 h x $25.00 = $ 0 Refrigeration.Unit>50OBtu h x $50.00 = $ 0 Re-inspection fee all x $75.00 = $ 0 Residential Range Hood x $15.00 = $ 0 Unit Heaters 15 100 Btu h x $15.00 = $ 0 Unit Heaters>100 Btu x $25.00 = $ 0 VAV Boxes(Variable Air Voltune,part of air x $10.00 _ $ 0 conditioning system) Wall Heaters-Gas Fired x $25.00 = $ 0 Water Heater- Gas Fired x $25.00 = $ 0 Permit Fee $ 25 Table 4-8; Plan Review Fee $ Processing/Tecluiology Fee $25.00 Total $ REV2.2020 Page 2 of PRESSURE PIPING SCHEMATIC COMPLETE FOR GAS PIPING ONLY ❑ SCHEMATIC IS TO SCALE ❑ SCHEMATIC NOT TO SCALE Show Pipe Size(s) and Length(s) from meter to all appliances NOTE: Any interior pressure regulators must be indicated 1,EV2.2020 Pagge 3 of3 MAINTENANCE 10 The motor and the fan wheel should be periodically inspected. "Urricaile Inspect every six months if continuously operated.The appliance maintenance shall be carried out only by qualified persons. All fasteners should be checked to make sure they are securely tightened. INLINE FAN SERIES In addition,all rotating items should be checked for easy mobility.When INSTRUCTION SHEET inspecting the unit,disconnect it from the power supply and any duct work. If debris is evident on the impeller,clean it with a damp(not wet)cloth. DO NOT use detergents or abrasive materials for cleaning. Hurricane Inline Fan Specifications PART# SIZE VOLTS AMPS WATTS CFM RPM WEIGHTAB. 736570 4" 120 0.95 113 171 2910 8 736575 6" 120 0.97 115 435 2915 9 736580 8" 120 1.72 198 745 2530 12 736585 10" 120 2.1 236 780 2480 12 736590 12" 120 2.5 300 1060 2575 16 BRACKET MOUNTING OPTIONS Please read instructions carefully before using this op product. Manufacturer will not be held responsible and declines any and all liability for damage caused to persons or property due to improper use with i reference to the precautions outlined in this manual. This manual explains how to correctly install, use and perform maintenance on Hurricane"'"inline fans. Follow these r instructions to ensure that the product will be electrically and mechanically reliable and extend its service life. Remove the inline fan from its package,and visually inspect for damage. • Make sure that the fan housing and the fan wheel are not damaged. • The fan wheel should rotate freely without catching or scraping the internal housing and be securely fastened to its rotation shaft. Contact a qualified person or place of purchase if there are any questions FIVE YEAR about the Huricane inline fan. • Do not leave packing materials within reach of children.Do not dump any WARRANTY materials into the environment(polystyrene,plastic,polypropylene,etc.]. • If the product is dropped or the box is damaged,immediately contact hurrjcaneyour retailer to check that the product operates properly. www.hurricane-fans.com CITY OF ARLINGTON BUILDING DEPARTMENT APPROVED DATE 3�2 3 Tl� BY ?eceived NO CHANGES AUTHORIZED UNLESS APPROVED BY THE MAR 19 ZOZO BUILDING INSPECTOR ���� 310� KEEP THESE INSTRUCTIONS READILY AVAILABLE INSTALLATION The installer must read the following instructions very carefully before GENERAL PRECAUTIONS using the product.The manufacturer will not be held responsible for injury to persons or damage to property due to improper use with reference to The use of electrical devices require compliance with these basic rules: the precautions outlined in these instructions. • DO NOT touch the device with wet hands,wet clothing,etc. • Do not exhaust hazardous or explosive vapors.For general ventilation • NEVER allow the unit to directly contact wet or moist environments. use only. • DO NOT allow the product to be operated by children or unskilled people. • The device must be installed by a professionally qualified electrician in • NEVER place anything near or in the intake or exhaust ports of fan. accordance with all applicable codes and standards,including fire-rated construction. Connect the product to the main power supply or electrical outlet only if: • To ensure optimum operation,do not block the air intake and exhaust • Your electrical voltage and frequency corresponds to those shown on vents.CAUTION:this unit has an unguarded impeller.DO NOT use in the rating plate. locations readily accessible to people or animals. • The main power supply is sufficient to operate the product at its maximum power. MODE OF INSTALLATION Wear gloves to safely move and/or install this inline fan. If power supply is not sufficient,contact professionally qualified personnel. Secure the Hurricane Inline Fan with clamps when attaching ducting • It is recommended that the product is switched off when not in use. [see Fig.1]. • Before carrying out any maintenance or cleaning,disconnect from the The wiring diagram is directly under the contact box cover[Fig.2]. power supply. When all electrical connections are complete,check that the connection • If a fault,malfunction or anomaly of any type occurs,disconnect from terminals are securely tightened,close the box lid and start the inline fan. power supply and immediately contact qualified personnel. NOTE:Because this fan comes pre-wired with a standard 120 volt power cord,no additional wiring modifications are necessary Always request original parts for any repairs. • If the product needs to be removed,turn off main circuit breaker and After the inline fan has started,check to make sure: then disconnect the device from that circuit. -The rotation direction is correct. Place the device in a safe location far from children and/or pets. -The absorbed current corresponds to the rating. The electrical system to which the fan is connected must comply with -Excessive vibrations compromise the appliance stability. the current standards&codes regarding electrical systems for the parts concerning the application of our devices. SPECIAL PRECAUTIONS • The Hurricane Inline Duct Fan is professionally manufactured and complies with the current standards regarding electrical equipment. • Do not use the product at an ambient temperature greater than 40"C[104"F]. FIGURE 1 • Do not allow the product to be exposed to rain,sun,snow,etc. • Do not place the device or relative parts in water or liquids. C • When cleaning or performing routine maintenance,check the condition of the device.Please see Maintenance Section for proper cleaning.To avoid risk of fire,do not use the product in the presence of flammable E)t* substances or vapours such as alcohol,insecticides,gasoline,etc. FIGURE 2 hurricane Hurricane verse S, yy2:116 �)c�ullr ► .��,crirrlc... .tit� cl h r. ..f i Ert4c c.*--,cam i i 22 20 17 H-7 i. l..� i f 18 DID i 12 1$ 13 i 19 i � j fl22 Peivd OLYMPIC SG LLC -- 104890.01 - -- -- - City ®f Arlie ton --- - _. It_LIP.IG F). ` g SI:.hVI(;': LOC�:TIc.)rd 11101120i 9 I 119 OLYMPIC N I 238 N, Olympic Ave, Arlington,WA 98223 - _ �t 360,403.34)_1 101 !1 19 10/31/2019 11/20/2019 $342.70 CHARGES AivIQUi Il" PREVIOUS READING PRESCN T READING CONSt Iflf TION + 070o11 505 347.25 Nay your bill online www.xpressbHipay.com You will be able to process a One-time P r e V i ou S B a l a n C e 0.00 payment,set up Auto pay and go Paperless.Click on the Sign Up button on the top of Ad J u s tin n t s the home screen.Fill In the email and password holds,then click I'm not a robot and Payments -3 47.25 tallow the prompts.Complete the short registration form and click Next,Go to your ,mail inbox,open the verification email,and click Verily Email.Than selec(Conilnk to :o log in.Select City of Arlington and follow the prompts for linking your bill. i Water Base 44.96 Water' COnsunlpti0n Water Usagg 14.85 fz 3000 Sewer 216.00 Stormwat,er 6,89 2000 Ambulance Utility Fee 60.00 Current Charges 342.70 1000 f ti Q Oel Nov Doc Jon Feb Mar Ape Moy Jun .ful Aug Sep Oc[ 7.010 20f9 Mier llsa a over Pasl 12 Willits, MAKE CHECKS PAYABLE TO CITY OF ARLINGTON TOTAL DUEIIII* 5342'70 KEEP THIS PORTION FOR YOUR RECORDS �- 1 i prll I jq:1LEA E READ THE BACK F IMPORTANT BILLING AND PAYMENT INFORMATION. _ _ - - - - - - - - - - - - - - - ;•II ru€{i_ Viso u ;l� pF Ee4S RETURN T IS PORTION UUlT1�1 YOUR PAYMENT 1 = 'a 11/01/2019 "' 104890,01 City of A l ington 238 N.OlyZic Ave. 11/20/2019 342.70 Arlingto ,WA 98223 Service Address: _ 7° 360.40 .3421 119 OLYMPIC N AMOUNT ENCLOSED 1-his sluh cr7sf1res fhgl your payment is processed accurately. 1 Please Make Check Payable To Name Relow: CITY OF ARLINGTON 1D04236 1 All- i?.412 AUTO ALL FOR AADC 980 238 N OLYMPIC AVE (Ll��lttl+Iltll{III�IIi�lil�{IIII�I��Illllutllltlll�{{i{IIII{tl 04357 Seq ARLINGTON WA 98223-1337 OLYMPIC 5G LLC 12 Still I of 1 I{Inl,tllil{It{ill,{III�I{III {t{y,Itil{{tlltt{Ilit�llll{Illl{,li 1D 0.49 C/O BILL STEWARD 1000 4320 FOWLER AVE u EVERETT WA 98203-3214 µ n-I.nu A9nnnnnnn,zuP,;ni. } t �.. q � 1_._e-of +y rnat�e. NAoA e1 v rm?cv(A-me.cA- posh S\tn\� -- �6hn3005-----3g1$2yy-Zp1$ C w ��-h 2 drGl�n b o�.Y A, ' , 5 7 r S✓o M�.c.1n tn.� 50\ moa c3 ._--•-r- Vj - Er�p1v�e�lCv5kom (e-Jry rr IGeG�eAr\ ------------- gCAg- He - bo\Y-e-A Cnooc\b A%sp\cx� 1 'B�rc)nc�c b\ock to - o.1 e.,n. V 1 c-U" ---- 351 FC C10 06 nA walk, S t n V— Goo"VO SP D pm Coo,�d Me:- r,\ oo c\ ve �e1 3or,nBaosfCa,-- �NC310 6 - w o L�ISEkY.L Z 0 - -VU \e-} 1 2 �G Y.C� tr1 23 - MoP 15� rJ4_ 1 i Pastry and cookie Sample Menu Chaotic Bakery Nicole Hinton 425.318.9954 Pastries • Cinnamon Roll $4.00 • Mini Pavlova $4.25 • Eclair $4.00 • Gourmet Brownie $3.50 • Croissant $3.00 • Specialty Croissant $4.00 Tarts • Lemon $4.75 • Seasonal $4.75 • Chocolate $4.75 • Mascarpone cheese $4.75 • Apple $4.75 Cookies • Drop cookies $2.75 • Gourmet Drop $3.25 • Decorated sugar starting at$3.50 • Ice Cream sandwich $7.00/Gourmet$8.00 Cake by the slice • Seasonal $3.75 • Frasier $4.50 • Cheese $4.25 • Daily $4.00 Whole Cakes • Seasonal 6"$35/8"$45 • Daily 6"$30/8"$40 Cupcakes • Seasonal $3.25 • Daily $3.00 • Premium $3.75 i r• o � NOTICE TO PERMITEE AND/OR OWNER ❑ PARTIAL APPROVAL ❑ CORRECTIONS REQUIRED ❑ DO NOT OCCUPY APPROVED PERMIT#: �7i104 AM PM DATE: .Z• z-o2{-' OBADDRESS: V1 1`1 01"6 'i 'Ir-. Ade LOT#: PROJECT: E L ` W�-r TYPE OF INSPECTION: r,l�-D z_J l &_ 1a Sc_ OTHER: a '� ❑ NO PERMIT-STOP WORK-OBTAIN PERMIT ❑ CONSTRUCTION IS NOT IN ACCORDANCE WITH APPROVED PLANS AND PERMIT -STOP WORK Cl STOP WORK UNTIL AUTHORIZED TO CONTINUE BY INSPECTOR. ❑ CORRECTIONS LISTED BELOW MUST BE MADE BEFORE WORK CAN BE APPROVED. ❑ WORK NOT READY FOR INSPECTION: $50 REINSPECTION FEE(PER IBC) MUST BE PAID PRIOR TO NEXT INSPECTION. ❑ CONTACT INSPECTOR 360-403-3551 ❑ CALL FOR REINSPECTION THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED WITHIN DAYS OR PENALTIES IMPOSED BY LAW MAYAPPLY. FOR INSPECTION CALL: 360-403-3417 v ff� INSPECTOR D E I� Cl PLANNING 0 CIVIL a BUILDING CITY OF ARLINGTON yti�' CITY OF ARLINGTON 238 N. OLYMPIC AVE-ARLINGTON, WA. 98223 PHONE;(360)403-3551 BUILDING PERMIT Address:119 N.Olympic Ave. Permit#:3104 Parcel 0:003789006016M Valuation:6300.00 OWNER APPLICANT CONTRACTOR Name:OLYMPIC SG LLC Name:Nicole Hinton Name: Address:4820 FOWLER AVE Address:5226 257th St NE Address: Ciry,State Zip:L•VERETT,WA 98203-3214 City,State Zip:Arlington,WA 98223 City,State Zip:, Phone: Phone:425-318-9954 Phone: LIC: LX P: MECHANICAL CONTRACTOR PLUMBING CONTRACTOR -------------- Name: Natnc: Address: Address: City,State,Zip: City,State,Zip: Phone: Phone: LIC#: EXP LIC#: F.XP: JOB DESCRIPTION PERMIT TYPE: Commercial Mechanical CODE YEAR: 2015 STORIES: CONST.TYPE: DWELLING UNITS: OCC GROUP: BUILDINGS: OCC LOAD: PERMIT APPROVAL 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY: NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 19.27. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID. IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. IBC IO/IRCI10. SALES TAX NOTICE:Sales tax relating to construction and construction materials in the City of t gWn must b reported on your sales tax return and coded ity Arl" t 3101. b y 3 z� Rio Signature Print Name Dat• Rcle scd By Date CONDITIONS Adhere to approved plans.Call for inspections. THIS PERMIT AUTHORIZES ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS.DRIVEWAYS,MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION. PERMIT FEES , Date Description Fee Amount 03/27/2020 Commercial Hoods $25.00 03/27/2020 Mechanical Commercial Plan Review $135.01 03/27/2020 Processing/Technology Fee $25.00 03/27/2020 Mechanical Misc. $15.00 Total Due: $200.01 Total Payment: S0.00 Balance Due: $200.01 CALL FOR INSPECTIONS BUILDING(360)403-3417 When calling for an inspection please leave the following information: Permit Number,Type of Inspection being requested,and whether you prefer morning or afternoon i CITY OF ARLINGTON 238 N. OLYMPIC AVE - ARLINGTON, WA. 98223 do PHONE; (360) 403-3551 BUILDING PERMIT Address: 119 N.Olympic Ave. Permit#:3104 Parcel#:00378800601600 Valuation:6300.00 OWNER APPLICANT CONTRACTOR Name:OLYMPIC SG LLC Name:Nicole Hinton Name: Address:4820 FOWLER AVE Address:5226 257th St NE Address: City,State Zip:EVERETT,WA 98203-3214 City,State Zip:Arlington,WA 98223 City,State Zip:, Phone: Phone:425-318-9954 Phone: LIC: EXP: MECHANICAL CONTRACTOR PLUMBING CONTRACTOR Naive: Name: Address: Address: City,State,Zip: City,State,Zip: Phone: Phone: LIC#: EXP: LIC#: EXP: JOB DESCRIPTION PERMIT TYPE: Commercial Mechanical CODE YEAR: 2015 STORIES: CONST.TYPE: DWELLING UNITS: OCC GROUP: BUILDINGS: OCC LOAD: PERMIT APPROVAL I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY; NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID. IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. IBC110/IRC110. SALES TAX NOTICE:Sales tax relating to construction and construction materials in the City of 4. t gton must b-reported on your sales tax return form and coded City of Arlington#3101. / 3 Zy Zo20 Signature Print Name Date Rcle sed By Date CONDITIONS Adhere to approved plans. Call for inspections. THIS PERMIT AUTHORIZES ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS,MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION. PERMIT FEES Date Description Fee Amount 03/27/2020 Commercial Hoods $25.00 03/27/2020 Mechanical Commercial Plan Review $135.01 03/27/2020 Processing/Technology Fee $25.00 03/27/2020 Mechanical Misc. $15.00 Total Due: $200.01 Total Payment: $0.00 Balance Due: $200.01 CALL FOR INSPECTIONS BUILDING(360)403-3417 When calling for an inspection please leave the following information: Permit Number,Type of Inspection being requested,and whether you prefer morning or afternoon (iFQ SNOHOMISH HEALTH DISTRICT WWW.SNOHD.ORG Environmental Health Division March 2, 2020 Nicole Hinton Project: New Food Service Establishment Subject: Chaotic Bakery Address: 119 Olympic Ave N, Arlington, WA 98223 Dear Nicole: After reviewing your plans with the Rules and Regulations of the State Board of Health, and with the policies of the Snohomish Health District, your plans for Chaotic Bakery have been approved. The approval was based upon the plans, menu, and food flows submitted 12/23/2020 and 3/2/2020. Any changes to the plans, menu, and food flows without preapproval from the Health District will void this approval. A preoperational inspection is required prior to operating permit issuance and approval to open for business. At the time of inspection the construction of the food service establishment must be complete and all equipment must be in place and in proper operating condition. Incomplete construction or equipment operation will result in a $195.00 re-inspection fee. Contact the Food Program office a minimum of one week in advance to schedule an appointment for the preoperational inspection. Please review the following requirements and conditions of operation before scheduling: 1. If during routine inspections it is found that the current amount of refrigeration in inadequate for the refrigerated storage needs of the facility then the number of menu items must be reduced to a level acceptable for the facility's amount of refrigeration. The menu item reduction will remain in effect until such time as additional refrigeration is installed and approved by the Snohomish Health District. 2. No food storage or preparation is allowed in the establishment prior to the preoperational inspection and approval to open for business. 3. This facility lacks a food preparation sink. No washing or rinsing of fruit or produce will be allowed without the installation of a properly sized food preparation sink. All fruit and produce must be obtained pre-washed from the supplier. Please note that some fruits and produce are currently not available pre-washed. 4. Three-compartment sinks must have rounded corners and integral drainboards at both ends. The drainboards of the three compartment sink must be sloped to the basins. The basins of the three- compartment sink must be large enough to fit the largest item needing to be washed. 5. All food service equipment, both new and used, must be listed by the National Sanitation Foundation (NSF) or equivalent for its intended use. 6. Plumbing must meet state and local codes. 7. The ventilation system shall be installed and operated to meet applicable building, mechanical, and fire codes. After you have passed your preoperational inspection, the annual operating permit application and all fees must be received by Snohomish Health District prior to opening for business. This facility will be classified as a medium risk food establishment with 0-50 seats. 3020 Rucker Avenue, Suite 104 ■ Everett, WA 98201-3900 ■ tel: 425.339.5250 ■ fax: 425.339.5254 Your application for a food service establishment permit from the Snohomish Health District may be approved during this inspection. However, it is the responsibility of the food service establishment operator/owner to obtain all necessary permits and approvals from all applicable agencies. Operating the establishment without required permits or approvals may subject the operator/owner to enforcement action by the appropriate agency. Changes or additions to the approved plans or equipment require pre-approval from the Snohomish Health District prior to implementation of the changes. A copy of the Snohomish Health District Appeals procedure is available upon request. An administrative appeal must be initiated with 21 days from the date of this email. Please contact me if you have any questions. Sincerely, 4."V, Kevin Chung Environmental Health Specialist Food Establishment Plan Review 425.339.8748 kchung(aD_snohd.org cc: Brent French, Snohomish Health District City of Arlington Building Department 3020 Rucker Avenue, Suite 104 0 Everett, WA 98201-3900 0 tel: 425.339.5250 0 fax: 425.339.5254 MAINTENANCE The motor and the fan wheel should be periodically inspected. urricane Inspect every six months if continuously operated. The appliance maintenance shall be carried out only by qualified persons. M All fasteners should be checked to make sure they are securely tightened. INLINE FAN SERIES In addition, all rotating items should be checked for easy mobility. When INSTRUCTION SHEET inspecting the unit, disconnect it from the power supply and any duct work. If debris is evident on the impeller, clean it with a damp (not wet) cloth. DO NOT use detergents or abrasive materials for cleaning. Hurricane Inline Fan Specifications ; PART# SIZE VOLTS AMPS WATTS CFM RPM WEIGHTAB. 736570 4" 120 0.95 113 171 2910 8 736575 6" 120 0.97 115 435 2915 9 736580 8" 120 1.72 198 745 2530 12 736585 10" 120 2.1 236 780 2480 12 736590 12" 120 2.5 300 1060 2575 16 BRACKET MOUNTING OPTIONS Please read instructions carefully before using this product. Manufacturer will not be held responsible �P and declines any and all liability for damage caused to persons or property due to improper use with reference to the precautions outlined in this manual. • This manual explains how to correctly install, use and • perform maintenance on HurricaneTO inline fans. FolloW these instructions to ensure that the product Will be electrically and mechanically reliable and extend its service life. Remove the inline fan from its package, and visually inspect for damage. • Make sure that the fan housing and the fan wheel are not damaged. • The fan wheel should rotate freely without catching or scraping the internal housing and be securely fastened to its rotation shaft. Contact a qualified person or place of purchase if there are any questions about the Huricane inline fan. FIVE YEAR • Do not leave packing materials within reach of children. Do not dump any WARRANTY 5 materials into the environment(polystyrene, plastic, polypropylene, etc.). • If the product is dropped or the box is damaged, immediately contact murr"lo'cane your retailer to check that the product operates properly. TM www.hurricane-fans.com KEEP THESE INSTRUCTIONS READILY AVAILABLE INSTALLATION The installer must read the following instructions very carefully before GENERAL PRECAUTIONS using the product.The manufacturer will not be held responsible for injury to persons or damage to property due to improper use with reference to The use of electrical devices require compliance with these basic rules: the precautions outlined in these instructions. • DO NOT touch the device with wet hands, wet clothing, etc. • Do not exhaust hazardous or explosive vapors. For general ventilation • NEVER allow the unit to directly contact wet or moist environments. use only. • DO NOT allow the product to be operated by children or unskilled people. • The device must be installed by a professionally qualified electrician in • NEVER place anything near or in the intake or exhaust ports of fan. accordance with all applicable codes and standards, including fire-rated construction. Connect the product to the main power supply or electrical outlet only if: • To ensure optimum operation, do not block the air intake and exhaust • Your electrical voltage and frequency corresponds to those shown on vents. CAUTION:this unit has an unguarded impeller. DO NOT use in the rating plate. locations readily accessible to people or animals. • The main power supply is sufficient to operate the product at its maximum power. MODE OF INSTALLATION Wear gloves to safely move and/or install this inline fan. If power supply is not sufficient, contact professionally qualified personnel. Secure the Hurricane Inline Fan with clamps when attaching ducting • It is recommended that the product is switched off when not in use. (see Fig.1). • Before carrying out any maintenance or cleaning, disconnect from the The wiring diagram is directly under the contact box cover(Fig.2). power supply. When all electrical connections are complete, check that the connection • If a fault, malfunction or anomaly of any type occurs, disconnect from terminals are securely tightened, close the box lid and start the inline fan. power supply and immediately contact qualified personnel. NOTE: Because this fan comes pre-wired with a standard 120 volt power cord, no additional wiring modifications are necessary Always request original parts for any repairs. • If the product needs to be removed,turn off main circuit breaker and After the inline fan has started, check to make sure: then disconnect the device from that circuit. The rotation direction is correct. Place the device in a safe location far from children and/or pets. The absorbed current corresponds to the rating. The electrical system to which the fan is connected must comply with Excessive vibrations compromise the appliance stability. the current standards &codes regarding electrical systems for the parts concerning the application of our devices. SPECIAL PRECAUTIONS • The Hurricane Inline Duct Fan is professionally manufactured and complies with the current standards regarding electrical equipment. • Do not use the product at an ambient temperature greater than •• •• 40°C (104°F]. p o FIGURE 1 • Do not allow the product to be exposed to rain, sun, snow, etc. • Do not place the device or relative parts in water or liquids. C • When cleaning or performing routine maintenance, check the condition of the device. Please see Maintenance Section for proper cleaning. yellow-green • To avoid risk of fire, do not use the product in the presence of flammable motor brownHL - substances or vapours such as alcohol, insecticides, gasoline, etc. black blueN FIGURE 2 Hurrjcaile Hurricane Permit#: 3104 Permit Date: 03/19/20 Permit Type: COMMERCIAL MECHANICAL Project Name: Chaotic Cookie Bakery Applicant Name: Nicole Hinton Applicant Address: 5226 257th St NE Applicant, City, State, Zip: Arlington,WA 98223 Contact: Nicole Hinton Phone: 425-318-9954 Email: chaoticcookiebakery@gmail.com Scope of Work: Install 36"x42" hood Valuation: 6300.00 Square Feet: 0 Number of Stories: 0 Construction Type: Occupancy Group: ID Code: Permit Issued: 04/08/2020 Permit Expires: Form Permit Type: Status: COMPLETE Assigned To: Raelynn Jones Property Parcel# Address Legal Description Owner Name Owner Phone Zoning 569 Other Retail 00378800601600 119 N OLYMPIC AVENUE OLYMPIC SG LLC Trade-Apparel& Accessories NEC Plan Reviews Date Review Type Description Assigned To Review Status 03/19/2020 COMMERCIAL BUILDING MECHANICAL Fees Fee Description Notes Amount Commercial Hoods Type I/II $25.00 Mechanical Commercial Plan Review Table 4-1 $135.01 Processing/Technology $25.00 Mechanical Misc. Not otherwise specified oven $15.00 Total $200.01 Attached Letters Date Letter Description 03/27/2020 Building Permit 03/19/2020 Building Permit Payments Date Paid By Description Payment Type Accepted By Amount 04/04/2020 Nicole Hinton 79774129 $200.01 Outstanding Balance $0.00 Notes Date Note Created By: 04/06/2020 Emailed permit for signature and approved documents to print for the job site. Kristin Foster Uploaded Files Date File Name 09/23/2021 9747967-3104 IC 4.2.2020 Hood.Plumbing w grease interceptor.pdf 04/10/2020 6502716-3104 Issued Permit.pdf 03/19/2020 6409955-3104 Application.pdf 03/19/2020 6409956-attachments CO20021000138396506 HSYTtErUQOS 11ATd70J 91AD5s1CR9S.pdf 03/19/2020 6409957-Re Inspection Request.msg