Section 16.03.22.110 - FACILITY LICENSE APPLICATION01.License Application. License application forms are available online at the Licensing Agency's website at http://assistedliving.dhw.idaho.gov. The applicant must provide the following information: a. A written statement that the applicant has thoroughly read and reviewed the statute, Title 39, Chapter 33, Idaho Code, and IDAPA 16.03.22, "Residential Assisted Living Facilities," and is prepared to comply with both;b. A written statement and documentation that demonstrate no license revocation or other enforcement action is in the process of being taken, against a license held, or previously held, by the applicant in Idaho or any other state or jurisdiction;c. When the applicant is a firm, association, organization, partnership, business trust, corporation, government entity, or company, the administrator and other members of the organization who directly influence the facility's operation must provide the information contained in this rule;d. Each shareholder or investor holding twenty percent (20%) or more interest in the business must be listed on the application;e. A copy of the Certificate of Assumed Business Name from the Idaho Secretary of State;f. A statement from the local fire authority that the facility is located in a lawfully constituted fire district or affirmation that a lawfully constituted fire authority will respond to a fire at the facility;g. A statement from a licensed electrician or the local or state electrical inspector that all wiring in the facility complies with current electrical codes;h. When the facility does not use an approved municipal water or sewage treatment system, a statement from a local environmental health specialist with the public health district indicating that the water supply and sewage disposal system meet the Department's requirements and standards;i. A complete set of printed operational policies and procedures;j. A detailed floor plan of the facility, including measurements of all rooms, or a copy of architectural drawings. See Sections 250 through 260, and Sections 400 through 430 of these rules.k. A copy of the Purchase Agreement, Lease Agreement, or Deed; andl. For facilities with nine (9) beds or more, signatures must be obtained from the following: i. The local zoning official documenting that the facility meets local zoning codes for occupancy;ii. The local building official documenting that the facility meets local building codes for occupancy; andiii. The local fire official documenting that the facility meets local fire codes for occupancy.02.Written Request for Building Evaluation. The applicant must request in writing to the Licensing Agency for a building evaluation of existing buildings. The request must include the physical address of the building that is to be evaluated and the name, address, and telephone number of the person who is to receive the building evaluation report.03.Building Evaluation Fee. This application and request must be accompanied by a five hundred dollar ($500) initial building evaluation fee.04.Identification of the Licensed Administrator. The applicant must provide a copy of the administrator's license and criminal history background check, and the current address for the primary residence of the administrator.05.Failure to Complete Application Process. Failure of the applicant to complete the Licensing Agency's application process within six (6) months of the original date of application, may result in a denial of the application. If the application is denied, the applicant is required to initiate a new licensing application process.Idaho Admin. Code r. 16.03.22.110