04-101938ECEIVED
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BUSINESS LICENSE APPLICATION
��-- Please type or print clearly in dark ink.
C�New Application ❑Update Application/Address Change
❑Federal Way Business ❑Outside Contractor 0"40me Occupation ❑Other
SECTION A — Business Information - Please comnlete au informatinn
Business Nam i 11
WA State UBI # (1-800-647-7706)
Number of Owners, Partners,
Date Business begarf
Business Location Address (Street/Suite#- Physical Li5cation Only)
or will be in in FW: t}U 3
City
State
Zip
Business Phone #:
Birth ate-
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Mailing Address
City
State
Zip
Business Fax #:
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Name:
Title:
Is this a Non -Profit Organization established for educational,
Number of persons employed in Federal Way:
religious, or charitable purposes? ❑Yes
# Full Time # Part Time
Is there Liquor served on the premise? ❑Yes
Is there Gambling activities? ❑Yes
If yes, State Liquor License #
If yes, State License #
SECTION B — Description of Business — describe in detail your business activities -including
which category - rgtail, wholesale, or services.
C V\ � ,.. .
SECTION C — Business Ownership -Attach additional pages if necessary.
llle Proprietor ❑Partnershin ❑Cnmoration ❑Limited I iahility ❑Nnn-Prnfit nnthar
Company Name
As re istered with WA State -
Number of Owners, Partners,
Date Business begarf
or Corporate Officers:
or will be in in FW: t}U 3
Name:
Title:
Driver Licens2e#/Statte:C
Social Security #:
Birth ate-
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Home Address (Street/PO Box, City, State, Zip)
Telephone Number:
% Own&
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Name:
Title:
Driver License#/State:
Social Security #:
Birthdate:
Home Address (Street/PO Box, City, State, Zip)
Telephone Number:
% Owned:
SECTION D — Business Location - Some improvements to your business may require separate
Dermits. Please contact the Community Develonment nermit counter nt 0531 ff,1-Al 16 fnr mnrn infnrmaHnn
King County Parcel #:
Are you making tenant improvements? ❑Yes pN
1 3x0 L?
Building: UlSrngle Tenant
Floor Space Used
Name of Business Center (if applicable):
❑MultiTenant
for Business (Sq. Ft.: / j 00
Does building/premise have
If monitor d by:
City alarm registration no.:
a security alarms stem? es ❑No
i -t
Name, of Emergency Notification/Contact:
Telephone No.:
5 U i i, Ci A or')
5 5" 5�
SECTION E - Hazardous Materials - Required by the Cit„ of Forforal Waif nna Gi _1___
Does your facility currently report to the Federal Way Fire Department under Sara Title III? ❑Yes
Does
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Does your facility currently use or store flammable materials? ❑Yes qUB__—
If yes, please list.
What types of hazardous materials and /or waste are used, stored, handled, processed, or generated by your
business? If additional space is needed, please attach a separate sheet(s) of paper.
What quantity (in gallons) of the above substance is stored on site at any given time?
(Excluding consumer commodities for household use packaged in quantities of less than five (5) gallons)
SECTION F — Home Occupation - If you are applying foran Adult Family Home orin-Home
Daycare please contact Community nnvninnr»nni r)___4.. __o _,, nro CCA _
rrai requirements.
Name all f mlly members who reside at the home arld work in the business, include yourself:
Name f ApartmentlTown ouse Compl :(If applicable) Complete Floor Space of Residence:
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Will there be any outside storage of goods, display of materials or outside activity? k s ❑No
If Yes, UF,lf
x Iain: ' �- �� r C.
Will thes require the use of heavy equipment, po er tom s or power sour snot common to a residence?
❑Yes Yes, please explain:
Will there be any pickup or delivery by commercial vehicles? t7Yes
If Yes, please explain type and frequency:
Will there be any visits to the home by clients, employees, or delivery services? 21es QNo
If Yes, please explain the number of deliveries expected: per week per month
Are there any conditions produced by EFolf
occupation such as noise, vibration, smoke, dust, odor, heat, or glare
which would exceed that normally proa single residence, or which could create a disturbing or objectionable
condition in a neighborhood? ❑Yeses, please explain type and frequency:
SECTION G— Temporary Business Activity - Temporary Licenses are granted for a specific
period, and are not to exceed 90 days in a calendar year.
Description -of Business/Activity:
Specific Dates of Temporary
Is site layout of area/structures provided? ❑Yes ❑No Signed Consent of Property Owner must be attached for
(including ingress and egress of area) approval. Copy of lease agreement is acceptable.
SECTION H - SIGNATURES
'1 (we) the undersigned, declare under the penalties of perjury and the denial of a license or revocation of any license
granted, that I (we) am (are) the applicant(s) or authorized representative(s) of the firm making this application and that the
answers contained, including any accompanying information have been examined by me (us) and that the information set
forth is true, correct, and complete. I also understand that I am responsible for notifying the City Clerk, in writing, of any
change in location or mailing address within thirty days. All licenses are nontransferable_ I understand my place of
business must comply with all federal, state, and local codes and ordinances.
X 11/(Af 11.e llis/ n4
Signature of applicant Title Date
VC"_ I :Cin L i , 0 bj V, P_ ,-
Application prepared by (please punt)Title Phone Number
Amount Received:
For office use only
Check No.: Date Received: Receipt No.:
Business License #: SIC CODE: Date License Issued:
CITY OF
Federal Way
MAY 1 8 2004
DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
CITY OF FEDERAL WAY 33530 First Way South
BUILDING DEPT, PO Box 9718
Federal Way WA 98063-9718
253-661-4000; Fax 253-661-4129
www c i
IN-HOME CHILD CARE
LAND USE APPROVAL APPLICATION
Name of Child Care:
Name of Applicant:
Application Fee: $35.50
Address of Child Care: DO
Mailing Address (if Different):
Phone Number:d5 3'-7-2-7-.2- Y96 Opening Date of Child Care
11 a -0c)3
PLEASE PROVIDE THE FOLLOWING: V61
/® Name of family member who resides on-site & operates child care: 00 k L- C`CA- X
® Copy of license from the Dept of Social & Health Services: U'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). '-+
® How many people living outside your home will be working at the child care:y
® 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.
Bulletin #029 — December 26, 2002 Page I of 4 k:\Handouts — Revised\In-Home Child Care Application
Hours and days of operation:►Y1-
@-�,Maxi11lu11l number of children you will take care of on any given day: _ ( 0
Number of children residing in the home: -:Z
Number of vehicles you anticipate coming to your home per day as a result of the child care (include
employees, customers, deliveries, etc.): (147' Please explain:
Describe any fencing & other buffering devices around the play area (height & materials):
The 1997 Washington State Uniform Building Code has special requirements for in-home child care
centers. Please provide the following information:
1. What type of house is it? O One story O Two story r (level O Split-level Ow/Basement
O Other:
2. A smoke detector shall be provided in all sleeping/napping reas and on each level of the home. Has a
smoke detector affidavit (enclosed) been completed? VYes O No
3. Does the home have an automatic fire suppression system (sprinklers): O Yes all -0
11,
4. Each floor level used for child cue purposes shall be served by two remote exits. Child care will be
located: O Basement first story O Second story O Level:
5. If in the basement, is there an exit at gro nd level (no steps, porches, or decks outside the door):
O Yes O No Q'Not Applicable
6. If in the basement, is there an exit at ground level and a self-closing door at the top or boom of the
interior stairway (steps, porches or decks outside the door OK): O Yes O No 1UfilotApplicable
7. If in the basement, is there an emergenf� escape window or door which leads to a public way:
O Yes O No G]�Qot Applicable
8. If on the second -story, is there an exit irectly to the exterior of the home that does not go through the
first -story: O Yes O No UXot Applicable
9. If on the second -story, is there an exit directly to the exterior of ti home and a self-closing door at the
top or bottom of the interior stairway: O Yes O No f Applicable
Bulletin #029 — December 26, 2002 Page 2 of 4 k:\Handouts — Revised\In-Home Child Care Application
a f �y7,+7
IN-HOME DAY URE fHEfKUST
Applicant: 16,o (U/ ;tet
Site address: ; o,
Phone #: - ; FW Business license : Payment: —
Smoke detector affidavit:� h
Neighbors
left: Pup�uyt,
Right:
Rear:
Rear..
Other:
Other:
Site visit d
Setbacks it
Are there:
Notes:
(opy of DSHS license:(y N
(Mo� noNsrnt
Y N
r n
r n
Y H
1 N
ate: 0�_ loping: �S-7- lot site:
i compliance? ' N # of off- street parking— fencing: �-CS_
lurk: Y h Y N
Signs: � h
Traft impacts:
Other issues:
iign off date:
Jayc -re\ 6eO �m
` CITY OF CITY HALL
Federal Way 33530 1 st Way South • Box 9718
Federal Way, WA 98063-9-9 718
(253)661-4000
www.cityoffederalway.com
July 29, 2004
Valencia Claxton
Wonderland Home Day Care
30218 29th Avenue S
Federal Way, WA 98003
RE; In -Home Day Care Approval
Dear Ms. Claxton:
The City's Department of Community Development Services has completed the review of
your in-home day care application. The land use application is approved with the
following conditions:
1. A business sign outside your residence is not permitted. Advertising flyers may be
distributed via approved methods, such as store windows or at the library. Flyers
may not be placed on mailbox clusters.
2. No outside alterations are permitted to accommodate the day care.
3. Drop-off parking is permitted only in the driveway area.
4. The maximum number of children allowed in your care is 6, per your DSHS license.
5. The in-home day care shall meet all requirements of the enclosed Uniform Building
Code sections 310.4, 310.9.1.6 and 310.13.
Your city business license will be forwarded to you. Please contact my office at 253-835-
2629 if you have any questions.
Sincerely,
K. L. Cimmer
Lead Development Specialist
cc: Scott Sproul, Acting Assistant Building Official
Cathleen Rossick, Licensing Specialist
File
Wonderland Home Day Care
•
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): es O No
11. Do the sleeping or napping rooms have a door directly to the exterior of the building: 9-Y-e'sO No
12. Do any one of the following uses occur next to the child care area: commercial -type (restaurant)
cooking kitchen, boiler, maintenance shop, janitor closet, laundry, woodworking shop, flammable
or combustible storage, or a nting operation:
O Yes o Which one?
13. If you answered yes to question 912, is re a one-hour fire -resistive separation between the rooms or
spaces? O Yes O No of Applicable
14. If you answered yes to question #13, are there one-hour rated and labeled doors or windows in the wall:
O Yes O No 7� d`Applicable
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, 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.
Vri e 4 r r (�_ I(& a cv')
Full Printed Name
y
Signature Date
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Planning Representative Date
_r
4 6j",w)
Building Division Representative Date
Bulletin #029 — December 26, 2002 Page 3 of 4 k:\Handouts — Revised\ln-Home Child Care Application
SITE PLAN EXAMPE
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
?0'
1st Street
0
14
PL = Property Line
Bulletin #029 — December 26, 2002 Page 4 of 4 k:\Handouts — Revised\ln-Home Child Care Application
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RECEIVED
MAY 1 8 2004
CITY OF FEDERAL
TTW�� AY
DEPARTMENT OF COMMUNITY D�v>��YME1Q'�$ERVICES
33530 First Way South
PO Box 9718
Federal Way WA 98063-9718
253-661-4000; Fax 253-661-4129
www cin/offederalway c om
NEIGHBOR NOTIFICATION
IN-HOME CHILD CARE
Va��MC i C,- Cl ck- Ktcso is proposing an in -
(Applicant's Name)
home child care at bZ a-9 t/— s �j�u03 As part 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 I , children already residing on the premises.
Please call the Federal Way Department of Community Development Services at 253-661-4115
if you have any question or concerns.
Are you the property owner?y Tenant?
of notification.
(Sign Name) `
l��>�r�i2 [ i."�✓'�� Lire L�� �'�
Bulletin #30 — December 26, 2002
Please sign your name as an acknowledgement
Name)
Address)
, State,
I5 -ho y
(Date)
ity Development Services at the above address.
Page 1 of 1 Oliandouts — Revised\Neighbor Notification
0
DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
33530 First Way South
PO Box 9718
Federal Way WA 98063-9718
253-661-4000; Fax 253-661-4129
ffederalway-coni
SMOKE DETECTOR AFFIDAVIT
IN-HOME CHILD CARE
Date: /r /ot-/
Print Owner's Name: V(,n,._tc " C ��}�{-�w Permit No:
Print Street Address: 3 Dom-% F5- 2�`_ 6LOC,_S
Print City, State, Zip: F Cr J` W\), q BUDS
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.
Owner's Signature: �v� I -
Bulletin #031 — December 26, 2002 Page I of l k:\Handouts — Revised\Smoke Detector Affidavit
91217 ....,.,,.. NONE.
UCErtsE MASER
DIVISION OF CHILD CARE AND EARLY LEARNING (DCCEL)
FULL LICENSE - FAMILY HOME CHILD CARE MAY x 8 20
fif.dompliance, with and pursuant to the laws of the State of Washington in meeting the minimum licensing re*f"P(Abi
Department of Social and Health Services, a full license is hereby granted to BUILDING DEPT
VALENCIA C. ELAXTON to provide child care for child
30218 29T" AVENUE SOUTH city of FEDERAL WAY zip code 98003
county of KING , State of Washington, in a family home licensed for a maximum of 6
Children on the premises including the provider's own children under twelve years when on the premises.
The`provider may have on the premises at any one time:
children, birth through 8 years of age; or When a qualified assistant is present, the provider may have:
LXX children, two years through XX years of age; or XX children, birth through years co
children, three years through XX years of age; or
LXX children, five years through XX years of age; or The allowed number of children under two years of age is: 2.
Limitations, if any:** CAPACITY INCLUDES RELATED CHILD OVER AGE 8 WHO LIVES ON THE PREMISES.
this license is issued on Nlarch 25, 2004 And expires on September 24; 2006
"A'e- .
Dated at KENT , Washington, this 5TH day of APRIL 2004
DCCELE UPERVISOR
_ ROBI IGH PATRICIA ESLAVAZ�EY
PROW YOUR NAME MERE PPMT YOUR NATE MERE
( 253 ) 3725966 ( 253 ) 372.6043
TREPMONE NUMBER TaEPMONE NUMBER
NOTE. This license Is not transferable, and is valid only for use by the individuals) to whom it is Issued and at the location described. hmued 1
Authority of Chapter 74.15 Revised Code of Washington.