Plan Review Form

Kandiyohi-Renville Community Health Board
2200 23^rd Street NE Suite 1080, Willmar, MN 56201
www.co.kandiyohi.mn.us — www.co.renville.mn.us
Kandiyohi County: 320.231.7800
Renville County: 320.523.2570
publichealth@co.kandiyohi.mn.us — rcph@renvillecountymn.com

Print
Blank
PDF

2024 FOOD AND LODGING PLAN REVIEW APPLICATION

ESTABLISHMENT INFORMATION

Business Name:

Street Address:

City: State:

Zip:

Telephone (business):

OWNER

Name:

Mailing Address:

City: State:

Zip:

Telephone:

Email:

CONTACT PERSON FOR ALL PLAN REVIEW CORRESPONDENCE

Name:

Mailing Address:

City: State:

Zip:

Telephone:

Email:

Review Kandiyohi-Renville Construction Guidelines for all construction requirements.

Failure to submit plans and appropriate fees for new construction or remodeling will not prevent the fees from being collected. In addition, any construction not meeting code will have to be corrected prior to opening.

PLEASE CHECK

New Construction Major Remodeling Conversion

CONSTRUCTION DATES

Anticipated Start:

Anticipated Completion:

PLEASE INCLUDE:

Floor plans

Drawn to scale

Show equip location

Room Finish Schedule

Floors, walls, ceilings

Equipment listing

Manufacturer name

Model number

Plans submitted without the above information will be considered incomplete.

SUBMIT PLUMBING PLANS TO:

MN Dept. of Labor & Industry

Plumbing & Engineering

443 Lafayette Road N

St Paul, MN 55155-4343

(651) 284-5063

Fee: $

The Plan Review Fee is equivalent to the establishment's license fee. Fees must be submitted with this application.

Make checks payable to: Kandiyohi-Renville Community Health Board

Drop files here to upload
If form needs resubmission all files will be saved, but not shown
except in the case of session expiration

This is to certify that I am the individual who is the subject/business owner of the requested application.

This statement is to certify that all of the information in this application is true and correct and has been provided by the above named subject/business owner.

I certify that the information provided on this application is accurate and complete.

Online Application Completed

ByDate