Laserfiche WebLink
Adult Family Home (AFH� LOCAL BUILDING INSPECTION CHECKLIST <br /> Code RMerrnces�201Z IRC Secilon RJ:S(WAC 51�St) <br /> APPLICATION NUMBER: <br /> �`� <br /> . __ . ____.__. .__ ..__— _ - ___ _ _ _.__—' _ .___ . __.. __.— . _._ <br /> f SEC710N5 1. 2.J, ANO J IdUST BE COMPLETED OY APPLICANT OEFORE INSPECTION WILI BE PROCESSED _ � <br /> . . ._. .— . . ... _ . _____ . -_. _. ___ . __._ . — _—___. ___ <br /> —__—. . . __ .. __ ___'_—_'_.__ .. " '—' __— . ._ '_—_ ___._.'_____- '— � <br /> I , , ' • , ' • <br /> SfIFFDDRE55 _IU"I ` �` ��ll'�D /�(J' , �V�/I.��L nS5FS50RSTAv,P�WCPIa.______.____ <br /> _ __ ""____'_.'_____—_—__'_ <br /> � . . � � • ' � • <br /> _ — <br /> .___._'____.__.__-- ___..__.. _. ..'___'___--__--__ I <br /> PFOf'[RTVC':�Po�Rtlt.!:F:_f_'[./__���.1.�L4(__--._�J��f—,1�ll�l��L._____ _ PAY1iNF.PHOt1E: /�I��.��%.J �O,/ <br /> FFHLICCPlSCEf1�14Ep�oiu�n[vp�._J�y_�Kf��L�--l../1�1/�1�7� �7/��L— DAYTi�'EPHONE ������%���� <br /> � -- __. .-�_____.� � .., — _ <br /> On a separate sheet of paper (8 �/: x ii) draw a floor pian (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 /> __ — — --- ------ � <br /> � � . <br /> L- — _ -- _- � <br /> I reit�fy undrr penrlly of paju�y Ihat Ihr 6dmmatiun furK��.lu��i by n��� i; bc•• er�t �i r��� i tr, Y.r I��r�.t rf my wrov,lydgc, ,nd lhal I <br /> am requeslmq nr 1 arn auihorited bY U�C urmrr uf !Le abore prrm s�: to na; ;..! L-sl i"`��.'t !o� the opc�almn nf an Adult I am ly <br /> Uame at Ihis bcd6un. I dgrcc lo hulJ hannlrcti Ilu� ��.intdntiw� r.m:lu.hi�., �mli i��,p�,��„_n., at my requrst, :is lo lny Aaim <br /> (induAmg mst5, r.prnsrs, anA attnmrys' Ires inonrM in thr invesnqahon nl vah rl.r.m1, r:n�rh mny 6r madr by any perscn. <br /> mduJing the untlersi9ncA, anA (Jed aqaintt the jurisd�r(ion, hut o�ily vAmro sinh �imm anses ouI of lhe rrhance of 1!�r <br /> �unsd�chon, Iedudmq fls ollico5 anA employees, upun Ne acc�rary n' IPe �n'oirnar,on suppl�eA �o Ihe�arisA��tlen as a part uf <br /> Uds apPbcatiun. //� / <br /> NFr,�Fl11IlF ___ V�( �Yi✓�- � ._. __ _ . UAih� . 7l.Id11.L.—___ . <br /> ,,/ J / � <br /> �PROPERTV OWNER ILAPPLICANT �LICENSEE <br /> T / <br /> Htective:�013 July 0] <br /> Upd�ted: 20131une <br /> V�. <br />