Facility License Application

01. 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: (3-15-22) a. A copy of the Certificate of Assumed Business Name from the Idaho Secretary of State; (3-15-22) b. A complete set of printed operational policies and procedures; (3-15-22) c. A copy of the Purchase Agreement, Lease Agreement, or Deed; (7-1-26) d. A detailed floor plan of the facility, including measurements of all rooms, or a copy of architectural drawings; and (7-1-26) e. The following must be obtained: (7-1-26) i. Occupancy permit 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; (7-1-26) ii. Occupancy permit that all wiring in the facility complies with current electrical codes; (7-1-26) iii. Occupancy permit or evidence that the facility meets local zoning codes for occupancy and local fire official documenting that the facility meets local fire codes for occupancy. (7-1-26) 02. Written Request for Building Evaluation. The applicant submits a request in writing to the Licensing Agency for a building evaluation. It must include the physical address of the building, the name, telephone number of the person who is to receive the building evaluation report, and be accompanied by a five hundred dollar ($500) initial building evaluation fee. (7-1-26) 03. Identification of the Licensed Administrator. The applicant must provide a copy of the administrator's license and criminal history background check. (7-1-26) 111. -- 114. (RESERVED) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.22 Department of Health and Welfare Residential Assisted Living Facilities Section 115 Page 8