8820 CORBIN DR 2022 Plans 2022-11-30

t - Adult Family Home (AFH) LOCAL BUILDING INSPECTION CHECKLIST Code References:2018 IRC Section R330(WAC 51-51) of APPLICATION NUMBER: 502 OZ—d.� SECTIONS 1.2. 3. AND 4 MUST BE COMPLETED BY APPLICANT BEFORE INSPECTION WILL BE PROCESSED SECTION 1-PROPERTY INFORMATION a G vl c#j i coCEL#: l3ala SITE ADDRESS: + ASSESSOR'S TAX/PARCEL#: - SECTION 2-APPLICANT INFORMATION PROPERTY OWNER NAME: V-461:4 tit66/4-&-5444 DAYTIME PHONE:i4 (J'Q C AFH LICENSEE NAME(IF DIFFERENT): ME61f4 i'A ` Al>44IA— 'F (LL 14 VBAYTIME PHONE: 7494. 49'4 SECTION 3- FLOOR PLAN On a separate sheet of paper (8 1/2 x 11) draw a floor plan (including all floors) of your prospective AFH. Include all sleeping rooms (bedrooms) indicating which bedroom is: A, B, C D, E and F. Label all components for exiting i.e., stairs, ramps, platforms, lifts and elevators. 8 8 RS t il JUN 0 6 2022 0 CITY OF EVERETT Permit Services SECTION 4- DISCLAIMER/SIGNATURE BLOCK I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and that I am requesting or I am auth. 'ed by the owner of the above premises to request inspection for the operation of an Adult Family Home at this location. I agre' •• hold harmless the jurisdiction conducting such inspections, at my request,as to any claim (including costs, expenses,and adorn; -es inc re• 'n the investigation of such claim), which may be made by any person, including the undersigned, and filed against the yin but • ly where such claim arises out of. the reliance of the jurisdiction, including its officers and employees, upon .cc y if th/ form/ supplied to the jurisdiction as a part of this application. +�� NAME/TITLE: ///,,_� �JI/�// 4 :"° I �l� DATE: Lvs4 13 PROPERTY OWNE' f paPPLICANT 0 LICENSEE Implementation Date: 2021 February 01 Updated:2021 February