HomeMy WebLinkAboutplan-check-worksheet Additional fee required when requesting Expedited Plan Check
Expedited Plan Check: ____Yes
First Response Due:
(7 working days) Alameda County
Environmental Health Department
PLAN CHECK WORKSHEET
Requestor yellow portion only
Establishment Name:
Food ( )Pool Spa
Phone No.:
City + Zip:
For Office Use:
Service Request No.:
Date First Received:
Census Tract:
Plan Checker: District E. H. Specialist:
Plan Review Log No. Unit _____________ -- _____________ -- _____________
Program Element: _______Fee: $____ Payment: $_______ Payment Type: _______
Hood-Program Element: _______Fee: $____ Expedited-Program Element: _______Fee: $____
Comments: ____________________________________________________________________
Activity Codes O = Office F = Field
CODE
TIME
.25/HR. DATE ACTIVITY
When project is completed/terminated, sign here: Date:
Circle one of the above Plan Check Worksheet
New Facility Existing
# of New Hood Exhaust fans Cannabis:New Dishwasher w/Hood
For permitted facilities make sure the establishment name and address match the current health permit.
PR#
AR#
INV#
*Identify Pool and Spa name if MORE than 1 at the site
All fields in the yellow box are required and must be legible to avoid delays
City + Zip: Street Address:
Requestor/Contact Person:
E-mail
Business Owner’s Name:
E-mail:
Owner’s Address:
Phone No.:
Identify Pool/SPA*
Facility IDChange of Ownership