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Get WA DSHS 10-410 2018-2024

(application fee $700) Relocation (application fee $2750) • Current AFH address: • Current AFH license number: Section 2. Information about Proposed Adult Family Home 1. NAME OF PROPOSED ADULT FAMILY HOME 2. STREET ADDRESS CITY STATE 3. MAILING ADDRESS (IF DIFFERENT FROM ABOVE) ZIP CODE CITY 4. FACILITY TELEPHONE NUMBER 5. CONFIDENTIAL FAX NUMBER 6. CELL PHONE NUMBER 7. EMAIL ADDRESS REQUIRED COUNTY STATE ZIP CODE Section 3. Landlord Information (Property Owner(s)) Does the .

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