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(A) the applicant;

(B) each person who has an ownership interest in the home;

(C) the chief executive officer of the unit or subunit of government, if the applicant is a government entity;

(D) the owner of the premises in which the home will be located, if the applicant is not the owner of the premises; and

(E) the administrator of the home;

(2) the name of the assisted living home, if known by a name;

(3) the address of the assisted living home or the proposed new location of the assisted living home;

(4) evidence that the administrator meets the requirements of 7 AAC 75.215, 7 AAC 75.220, and 7 AAC 75.230;

(5) repealed 4/6/2002;

(6) the number of individuals within the maximum occupancy number established by the fire safety inspection required under 7 AAC 10.1010 that a home intends to serve;

(7) the number of residents the home intends to serve who are expected to be persons who

(A) have a primary diagnosis of mental illness or physical or developmental disability; or

(B) are elderly or suffering from dementia, but who are not mentally ill;

(8) the services the home proposes to offer;

(9) copies of all permits and approvals required by state or local government agencies, other than the department, for construction or operation of the home;

(10) any request for a general variance from a provision of AS 47.32, 7 AAC 10.1000 — 7 AAC 10.1095, or this chapter, as provided in 7 AAC 10.9500 — 7 AAC 10.9535 and 7 AAC 75.405;

(11) a staff plan that describes the number of employees that will be employed by the home and each employee’s responsibilities; the application must indicate that the home is prepared to modify the proposed staff plan to meet the terms of an individual residential services contract executed under AS 47.33.210 or an assisted living plan prepared under AS 47.33.220 and 47.33.230;

(12) a disaster preparedness and emergency evacuation plan that complies with 7 AAC 10.1010 to protect the residents of the home from a disaster or other emergency;