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09-100832 • • .....„...... DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES RECEIVEC 33325 8th Avenue South CITY OF PO Box 9718 Federal Way Federal Way WA 98063-9718 rr 11pY Yay MAR 0 2009 253-835-2607;Fax 253-835-2609 n.„..,...7. S'�' www.citvoffedcralway.com vi f CITY OF FEDERAL WAN, ISO CDS lr lk%I.6 IN-HOME CHILD CARE 09- 160 8�. ,, LAND USE APPROVAL APPLICATION Application Fee: $48.50 Name of Child Care: \�'\(A rf L--a Name of Applicant: ,1\1)(L(l 7(, 1--C. ( ;j`cu' — Address of Child Care: 33 7 Q.e S " Af G L. \-\--,,..A, (A).-A Mailing Address(if Different): Phone Number: .:. ''�(> t. ,,;)-(c.),)-.) Opening Date of Child Care: ,,��3, n,{17 � .3 'S '4,-4;0)1'. I n a ,,,0,!!, .;64'' 2-'e .. ate. ft,-7,% ti AS L ,`er .1,1.,=-,.0',,,,,,„;.4.,,,,,:, * S a® i,,4 ' , p , l7 1ss ° " .I%f i— x '..3„, fief k L � br 4 4 . � vs' ,� - ;r ��X�. r �p mrw 's a x'u 4 �k y: ifs � �* cy � � �- !,.:4,q1.."), � n ' ,' ys cr D 1���&C 3 .'.� - ' � vb - E X' 3 ss.$ ar fix` rx`s '°.X '' 9 i y ' z£—;n toad 1;,,,;,„:?tea -ssvkw r:6 ;: �' �4a !-- ;-. `' ' 'X�' f `,,,,e P� ayBF gyp", .'�r e k«y'yx € m� 'C ,' ' , r'£l �raf; ` kd 1 a .3,r` ¢J # ✓ # -;;12'. a. rte : � . r _ ��,, a, t o x � � d �' 3 �� - � E .:'(-4:,t.,-, �� / � ��.� roy � � y`4.-4.-~,-", ,—;.,;:,,,z,. ms;.,` ...1L p A %re , a , � „,2. ,. ',ca PLEASE PROVIDE THE FOLLOWING: 2--- I�s ame of family member who resides on-site&operates child care:/ V)(i.„C. �', Q d✓ r /Copy of license from the Dept of Social&Health Services: 0 Enclosed ® A sketch of your lot that shows your home in relationship to your lot lines. Show where any off-street parking is provided as well as loading and unloading area(see example on page 4). U How many people living outside your home will be working at the child care: (— Er Completed&signed Neighbor Notifications(enclosed)for each neighbor adjacent to your home,or provide the city with stamped, addressed envelopes of the neighbors' addresses and the city will notify them. Note, please do not submit metered envelopes. The Federal Way Post Office may refuse such envelopes. Bulletin#029—January 1,2009 Page 1 of 4 k:\Handouts\In-Home Child Care Application • IP t ❑ Hours and days of operation: ❑ Maximum number of children you will take care of on any given day: ❑ Number of children residing in the home: • ❑ Number of vehicles you anticipate coming to your home per day as a result of the child care (include r employees,customers,deliveries,etc.): _J 0 C Vit:'` Please explain: -YQ4C\C,\ 0.\{ ': \i\Q \i ‘Ac -\\N ' -- \CL,�1 C'CV- 6- Q\ �•(\ s 'Describe any fencing&other buffering devices around the play area(height&materials): \ l MOACt i3h " q VYkQ \-c. la/cc\ � 1: ` .p G� i&Q kin CA o 0 .. . . 4. The International Building Code(IBC)has special requirements for in-home child care centers.Please provide the following information: 1. What type of house is it? pne story 0 Two story 0 Tri level 0 Split-level ❑wBasement 0 Other: 2. A smoke detector shall be provided in all sleeping/napping areas and on each level of the home. Has a smoke detector affidavit(enclosed)been completed? ❑Yes 0 No 3. Does the home have an automatic fire suppression system(sprinklers): 0 Yes 0 No 4. Each floor level used for child care purposes shall be served by two remote exits. Child care will be located: 0 Basement ) l First story 0 Second story 0 Level: 5. If in the basement,is there an exit at ground level(no steps,porches,or decks outside the door): ❑Yes 0 No .©Not Applicable 6. If in the basement, is there an exit at ground level and a self-closing door at the top or bottom of the interior stairway(steps,porches or decks outside the door OK): 0 Yes 0 No 0 Not Applicable 7. If in the basement, is there an emergency escape window or door which leads to a public way: ❑Yes 0 No 0 Not Applicable 8. If on the second-story,is there an exit directly to the exterior of the home that does not go through the first-story: 0 Yes 0 No . 1 Not Applicable 9. If on the second-story, is there an exit directly to the exterior of the home and a self-closing door at the top or bottom of the interior stairway: 0 Yes 0 No '1J Not Applicable Bulletin#029—January 1,2009 Page 2 of 4 k:\Handouts\ln-Home Child Care Application 41111 • 10. Do the sleeping or napping rooms have at least one operable emergency escape or rescue window(5.7 min sq. ft.,20 inch min. width, 24 min. height,and 44 inch max. sill height): .0 Yes 0 No 11. Do the sleeping or napping rooms have a door directly to the exterior of the building: .0 Yes 0 No 12. Do any commercial uses occur next to the child care area: ❑ Yes 0 No If Yes,type of business use: 13. If you answered yes to question#12, is there a fire-resistive separation between the rooms or spaces? ❑ Yes 0 No D Not Applicable If Yes,what is rating? 14. If you answered yes to question#13,are there rated and labeled doors or windows in the wall: ❑ Yes 0 No 0 Not Applicable If Yes,what is rating? 15. Building Division Comments: A BUSINESS SIGN OR OUTSIDE ALTERATIONS TO YOUR RESIDENCE ARE NOT PERMITTED. I have read and understood that failure to comply with Federal Way City Code, Chapter 22, Article XIII, Division 6, Section 22-1069,"Home Occupations Class II,"is grounds for immediate revocation of the in- home child care approval. I agree that my child care will be conducted in such a manner that none of these criteria will be violated and that I will report any changes in the conduct of the above described child care (including increases in clients) to the Federal Way Department of Community Development Services and receive approval before the changes take place. `r\C“ q2('1, t��i\C Full Printed Name 1.1)?(. g A j ta Si attYre Date ,---- ...4x.4 imb."______ / s Planning Representative II a - Buildin ivision Representative Date Bulletin#029—January 1,2009 Page 3 of 4 k:\Handouts\In-Home Child Care Application • • • SITE PLAN EXAMPLE Include the following on the site plan: 1) Lot boundaries and dimensions 2) Dimensions between property lines and the house 3) Any areas used for parking,loading,and unloading 4) Adjacent streets 5) North arrow A .. 35 ' PL • V C > 2 0PL = Property Line C S o 8 ' .-t House Garage N I turiveway c.rt1 30' a.3 1 c.ts PL--- • f 70 ' 1st Street Bulletin#029—January 1,2009 Page 4 of 4 k:\Ilandouts\ln-Home Child Care Application • • - /OD 8N IN-HOME DAY CARE CHECKLIST Applicant: Pct r cx- ILA av veu-, Deol 3 Site Address: 3 ?1P 57 `a$u�2..S� Parcel Number: 9 3Q0100 so Phone No 9156-40,0 FW Business license: ed t.A4 Payment: Smoke detector affidavi N Copy of DSHS license: Y Neighbors Notice sent Notice Rec'd Left: 33311 -2bli`Ave Std O N O N Right:33,305 Z LorkAcv.04NZ p N 0 N Rear: Y N Y N Rear: Y N Y N Other: Y N Y N Other: Y N Y N Site visit date: N/A Zoning: k 7,Q Lot size: 36"0___ Setbacks in compliance? Y N #of off-street parking: Fencing: yes Are there: Curbs Y N Sidewalks Y N Signs Y( Traffic impacts: Other issues: ctris42 Notes: Cyt.44.Gws O r) V *ID/O• _i, A. Sign off date: 7/21/06 Sent letter w/enclosure • • • /CO DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES 33325 8th Avenue South CITY OF PO Box 9718 Federal Wa tFederal Way WA 98063-9718 253-835-2607;Fax 253-835-2609 www.cityoffederalway.com NEIGHBOR NOTIFICATION IN-HOME CHILD CARE Ai\ e Y i t-2- I (a ` is proposing an in- (Applicant's Name)home child care at 333 0 ? _ �-� IA 4. v J w Ve.12-cci (A,0;1:As o the (Address) Federal Way in-home child care application process,notification of adjacent neighbors is required. Each adjacent neighbor should read and sign this form. (Applicant,please make as many copies as necessary.)This child care will have a maximum of y children at any one time, including 0L- children already residing on the premises. Please call the Federal Way Department of Community Development Services at 253-835-2607 if you have any question or concerns. Are you the property owner? Tenant? }C Please sign your name as an acknowledgement of notification. oThal- rOfir 1 r/ (Sign Name) (7 q (Print Name) t J (Date) 3✓3 �}L G (Street Address) 1"CC6rr 1 L :q CA).14 r`.2 3 (City,State,Z ) Return to the Department of Community Development Services at the above address. Bulletin#30—January 1,2007 Page 1 of 1 k:\Handouts\Neighbor Notification , lc! ---/O6K3 • DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES 1.... ,, 33325 8th Avenue South CITY OF PO Box 9718 Federal WayFederal Way WA 98063-9718 253-835-2607;Fax 253-835-2609 www.cityoffederalway.com NEIGHBOR NOTIFICATION IN-HOME CHILD CARE .7)?cetle--( 4q*A-A-/-°--(6 is proposing an in- 4 (Ap ' ant's Name) home child care at 3.3.50? Z4 4c e -564-) #! atty, o,9- pan of the (Address) Federal Way in-home child care application process,notification of adjacent neighbors is required. Each adjacent neighbor should read and sign this form. (Applicant,please make as many copies as necessary.)This child care will have a maximum of children at any one time, including (,)-- children already residing on the premises. Please call the Federal Way Department of Community Development Services at 253-835-2607 if you have any question or concerns. Are you the property owner? Tenant? K Please sign your name as an acknowledgement of notification. / -- ii _. Lis T - LA .. '- ec1 (Sign Name) (Print Name) (Date) 333 i 1 zits. A S t_TeLitert( treet Address) 645 WA t6 2-1 (City,State,Zip) Return to the Department of Community Development Services at the above address. Bulletin#30—January 1,2007 Page 1 of 1 k:\Handouts\Neighbor Notification 0 4.) -/0 0 23 116„, DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES CITY OF 9 33325 8th Avenue South Federal WayPBox 9718 Federal Way WA 98063-9718 253-835-2607;Fax 253-835-2609 ww w.c i t vo ffederal w ay.com SMOKE DETECTOR AFFIDAVIT IN-HOME CHILD CARE Date: _ C)- (7 Print Owner's Name: C,.r A 20... f (APermit No: Print Street Address: ')jbO1 2(Q AU Print City, State,Zip: CUAT.A.A.... (..),-- , 1,(. C C. 2,6 I hereby certify, under perjury, that a properly operating smoke detector has been installed in the dwelling unit within the building for which this application is being made. )1 Owner's Signature: O4Q1 A I-II oy Bulletin#031 —January I,2006 Page 1 of I k:\Handouts\Smoke Detector Affidavit