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Adult Futltily H0111a (AFH) LOCAL [BUILDING INSPECTION CHECKLIST <br /> Code Refrrnnccsl 1QjQ 111C Section 8330(WAC 51.51) <br /> APPLICATION NUMBER. Zl>1 O "' I -z- <br /> SEC1iONS 1.2 a.AND A MUST DE COMPL1300 ny 0111,10ANT Onpolill 1119PEOTION WILL BE PFIOCESSED <br /> ,rnc At,nnL `3 ' sorr'aTAxmnacE:8 4o��SS �6�Z`fttSti'v <br /> --- <br /> ��t( <br /> PROPLR1Y OIhNTR N&VAE: <br /> �IL- N J(� /J�10 A2hM /41 NJV DAYTIME PHONE: ?' <br /> Ahl UCLt��EE t.N1E(I'onrtacHi): <br /> L L G DAYTIME PHONE: Zb6'�I RZ�3238 <br /> On a separate sheet of paper (S 1/7 x 11) draw a floor plan (including all <br /> floors) of your prospective AFH. Include all sleeping rooms (bedrooms) <br /> indicating which bedroom is: A, B, C D, E and F. <br /> Label all components for exiting i.e., stairs, ramps, platforms, lifts and <br /> elevators. <br /> and <br /> I am <br /> I cWyrundX l en lautt orlrcd�du b 1113t tile Inf <br /> owner of lhroabo Qi shedpre1by me Is t0 true lnlllspect onect tforirtile operatioe best of n ofanAdult Family tHome <br /> rr�ue b vj by <br /> person, Induding the undersigned <br /> at U�is lrcatlon, l agree In hold frarrnless the jurisdiction conducting such Ins�ectlons, at my request,as to any claim(including costs, <br /> upenses,and attorrre s'fees Incurred in lire Investigation of such clrllm), Which may be made it any <br /> and filed agbinst the �urisdicllon, but only owhere nuch Claim arises c Out of tile jurisdiction relicas 0nce part off this jurisdiction, <br /> Including Its officers an <br /> ernptv/us, ui�,n IIIc awnacy of lha Inf r <br /> PIle <br /> r4nrAul n l.u:_f3139oN_w <br /> n��,e �UA6Y. nRMn <br /> IY(rIJ>11a�) ll <br /> 1.1CFNSVC <br /> MAR 12 2024 <br /> Implementation Date;2021 February 01 <br /> CITY OF FVERETT Updated.2021 February <br /> Permit Services <br />