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Adult Fancily Home (AFF ) LOCAL BUILDING INSPECTION CHECKLIST <br /> Cody Rrfeten(et: 2010 IRC SedInn 8330(WAC 51-51) <br /> APP[ICATION Nl111171ER: F2 23 1 Q —D 1 Z <br /> -SECTTONS 1.2. 3. AND 4 MUST DE COMPUnn ny APPLICANT REroRE INSPECTION WILL BE PROCESSED <br /> • PROPERTY • • • <br /> O <br /> —3�jt.0$ �g! eT F <br /> C.1 er-ef I J. <br /> W _ASSES;OnsTAPPARCEu U0S6�L.`tS ISS <br /> [ 0hPPgt GC _ --- - <br /> SECTION APPLICANT INF• • • <br /> i".:.r`[RTl'C►h".[h '<A"'E: I�t�l�e NJ*IE /NoFy PTfLMn M NYC DAYTIME PHONE: <br /> qrH uaNSEE NAME l;r D;rrtar"rn <br /> n/A-�►J�� L L G DAYTIME PHONE: <br /> On a separate sheet of paper (8 '/z 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 /> I am <br /> 1 cr�U/y unrrr hff1Oeul1'�rl/rdrlY tlnc� Uwncrool Ilu�ahovcl�prcn�lied ses to rcquesle is true rtlnspectionrect lforlilhe opee best °atiot of ancAdultaFamily tHon z <br /> r�u�Ur✓) 0 1 am Y <br /> ing costs, <br /> at Un. k"t)un. 1 arlrr-�' it) hold harrnie',: the )urkdlctlon Conducting such Inspections, at my reglnylpersonas to,lnduding claim the luaderslgned, <br /> ei n.f and attr,rr�ry;'fec.Incurred In the InvesUca tUon of such claim),out of vi may be mide tlie by <br /> and filed orjain:t ll,e jun%dictiorri,fbut only <br /> wilf Suchppile11 d lols►he Jurlsdlcllion as ie ila part. ofance thisthis jurisdiction <br /> Including its officers and <br /> �I'lll)I'I.II 11'1)�Y'�I Il <br /> Implementation Date: 2021 February 01 <br /> Updated: 2021 February <br />