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07-104760 • • ` CITY OF CITY HALL 33325 8th Avenue South 4trati . Federal Way Mailing Address: PO Box 9718 Federal Way,WA 98063-9718 (253)835-7000 www.cityoffederalway.com tZfo :1117 September 13, 2007 Josef&Jazzmine Benisa 3903 336th Place Federal Way WA 98023 RE: Permit#07-104760-00-BL; WATCH ME GROW CHILDCARE 3903 SW 336th Place Dear Mr. and Mrs. Benisa: 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 and pick up is permissible in the driveway and other allowed parking areas. 4. The maximum number of children allowed in your care is 6 or 12, with additional supervision, per your DSHS license. 5. The in-home child day care shall meet all requirements of the enclosed International Building Code, sections R310, R313.3, and R325. Your city business license will be forwarded to you. Please contact my office at 253-835-2626 if you have any questions. erely, Robin Baker Development Specialist c: Cathleen Rossick,Licensing Spedalist File Doc.I.D.42399 RECEIVED 114195 Wash,apfoa State LICENSE NUMBER AUG 2 9 2007 Department ofSocul 949329 &HeilthSereices PROVIDER NUMBER CITY OF FDERALII�INCSION OF CHILD CARE AND EARLY LEARNING (DCCEL) F ' 9N1TIAL LICENSE - FAMILY HOME CHILD CARE In compliance with and pursuant to the laws of the State of Washington in meeting the minimum licensing requirements of the Department of Social and Health Services, an initial license is hereby granted to JAZZMI-NE Y. BENISA to provide child care for children at 3903 SOUTHWEST 336TH PLACE city of FEDERAL WAY zip code 98023 , • 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: 6 children, birth through 11 years of age; or When a qualified assistant is present, the provider may have: 8 children, two years through 1i years of age; or - XX children, birth through XX years of age. 10 children, three years through .A years of age; or 10 children, five years through `re" ' years of age; or The allowed number of children under two years of age is: 2. Limitations, if any: This license is issued on J16 17, 2007 And expires on January 16, 2008 • • Dated at KENT , Washington, this 14TH day of AUGUST2007 • ���l\�!ll l;ul ,,iii / /, F n jI SORAID '` ow 'f7TEN •- /RV �� �;, - 7.L7-4HARRIETT MA'T PATRICIA ESLA SSEY �\ PRINT YOUR NAME HE PRINT YOUR ERE H t ( 253 ) 372. 5982 ( 253 ) 372.6043 TELEPHONE NUMBER TELEPHONE NUMBER 1'',. " NOTE: this license is not transferable,and is valid only for use by the individual(s)to whom it is issued and at the location described. Issued by /,' ,\' Authority of Chapter 74.15 Revised Code of Washington. / /1/1/,i110'"\\'` 1 `\• DSHS 10.092A(REV.0112004) • D • RECEIVE DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES AUG 2 9 2007 33325 8th Avenue South CITY OFri+'v PO Box 9718 Federal Way CITYBUILDING OF FEDEDERAL PTWAY Federal Way WA 98063-9718 . 253-835-2607;Fax 253-835-2609 WW w_cityoffcderaIway.com NEIGHBOR NOTIFICATION IN-HOME CHILD CARE JQ22/flI1 G ej,id .l` f 1 I3 -i 'Sc is proposing an in- (Applicant's Name) home child care at 3 r°-3 3-141 &-3 6-An p/ . 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 4 "/0 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? Please sign your name as an acknowledgement of notification. /D4-1 //i/Oc7-- (Sign Name) (Print Name) (Date) eit) S et ess ar (City,State,Zip) Return to the Department of Community Development Services at the above address. Bulletin#30-January 1,2007 Page 1 of I k:\Handouts\Neighbor Notification • RECEIVED • AUG292007 DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES CITY OF FEDERAL WAY 33325 8`"Avenue South CITY OFr'� BUILDING DEPT. PO Box 9718 Federal \/'t(ay Federal Way WA 98063-9718 253-835-2607;Fax 253-835-2609 www.citypffederalway.com NEIGHBOR NOTIFICATION IN-HOME CHILD CARE jGi 7 Z41/%!e a--7d J '���� is proposing an in- (Applicant's Name) home child care at 3r62-3 -S 4-%-/ 236 /1 . 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 /0 children at any one time, including 1 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? Please sign your name as an acknowledgement of notification. /1/1t0N--- t o ma-- Cavr( 1 (0 / (Sign ame) (Print Name) 11 ate) .51(2— (Street (2(Street Address) • 411114/74J - c)4- Z . . ( (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 r , , • RECEIVED • AUG 2 9 2007 DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES CITY OF FgBWRALNNAY ,33325 8th Avenue South CITY OFoe BUILDING DEPT, 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 Jaz7Ine Q.-id J e7' 8E'_/Ii sem- is proposing an in- (Applicant's Name) home child care at g?0S S t,_i Z-3 nth p1 . 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 —/0 ,Achildren 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? Please sign your name as an acknowledgement of notification. ------ / 6f/111' .� /l2- �� C7 (Sign Name) _ (Print Name) (Date) .39 sui 3=37 3/ (._.(1' ,.- (Street Address) �Q . wilf (41P7- g' ? (City, State,Zip) Return to the Department of Community Development Services at the above address. Bulletin#30—January I,2007 Page 1 of I k:\Handouts\Neighbor Notification Print Map Page Page 1 of 1 ing y ��� Hramc� N�ov� �t'rvi�ces C�rrtmenks Se�tr+rh i 3°1(° Silt) Parcel Map and Data 5 2 7 91100 23(1 3'� 3279004730 3x7Li004280i. , It 9211510430 921150380,` ° 7....---r-– ._£. — T- 92115104410 _ 9x115iallo (/ 'j l , f.... 9211510420 9211514x90 � s+ 9211310390E , .. F ,Iiisto3 .✓--ti92115144!17._ _ .. , .5q°° /✓/ i 9x1r :r t r`" `7"', 921!310/00 = 9x115142!1? r-9x11310300 t 2115142749211514314 510 ,1 921151 90 i 921151052011310220 w � 921151' r -Tr-----.4 9211510540 '9211510260'. ,-" ,< • 9211510600 -'Federal a,y<. .t '9211 :,' r• • t 9x!15!0590 92113!0580 9211510550. ra .. £ 0211310570 ---,.. '''''''..• / 9211510560 • °921197 E n ~ ll N r (92115!4700 I''''' ,-- 02!1514740( =, , i I S5 G121 s.. F 9211510720 9211310730•. 9211510750 a � 9�1l31b714 � ° 9211514760; , ' `_,, /9211510690€ :'9211510910 • `— . ..._.9211510930 :. 02115106801-- - ' - —1.-- 1 9211500740 Parcel Number 9211510540 Address 3903 SW 336TH PL Zipcode 98023 Taxpayer NGUYEN KHANH D+CINDY T VU The information included on this map has been compiled by King County staff from a variety of sources and is subject to change without notice.King County makes no representations or warranties,express or implied,as to accuracy,completeness, timeliness,or rights to the use of such information.King County shall not be liable for any general,special,indirect,incidental,or consequential damages including,but not limited to,lost revenues or lost profits resulting from the use or misuse of the information contained on this map.Any sale of this map or information on this map is prohibited except by written permission of King County." 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The details. http://www5.metrokc.gov/parcelviewer/Print_Process.asp 9/6/2007 0 0 RECEIVED AUG 2 9 2007 CITY OF FE[SERAL WAY BUILDING DEPT. `;' ' C) /,\ '\ h '-' - c of1 V L -> — 2 , i' - ---- -,__ c, v ‘- -------i----------____ \ ' :'.<y j j 1 L L� 1 r U `'✓ • 414 RECEIVED DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES CITY OF rmoor AUG 2 9 2007 33325 8th Avenue South PO Box 9718 Federal Way CITY OF FEDERAL WAY Federal Way WA 98063-9718 BUILDING DEPT. 253-835-2607;Fax 253-835-2609 www.cityoffederalway.com SMOKE DETECTOR AFFIDAVIT IN-HOME CHILD CARE Date: d '? 3 Print;Owner's Name: V ;S Permit No: rt Print Street Address: 3t235 - / Print City, State, Zip: Fee/eye-1 tviy, 44 qS b .3 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: Bulletin#031—January 1,2006 Page 1 of 1 k:\Handouts4Smoke Detector Affidavit 4: : 41110 RECEIVED DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICFS AUG3325 8th Avenue South CITY ol: .�•� G 2 9 2007 PO Box 9718 Federal Way ciTy0FFederal Way WA 98063-9718 eUl �gp AL 253-835-2607;Fax 253-835-2609 LONG ptPTWgy www.cityoffederalway.com IN-HOME CHILD CARE LAND USE APPROVAL APPLICATION Application Fee: $44.00 Name of Child Care: WSc1 4ll 6 re w Ck o ca✓e_ Name of Applicant: JaSe--is enASCA- Address of Child Care: 3 903 St 33(01-''‘ D1 Mailing Address(if Different): . - Phone Number: (2-c3,),C29 0 3O2 Opening Date of Child Care: July /(oi ' .'y„�:iF. �"�w,.."tik». Vit'' -..,�:z> �x�;•'�'`�-':.fid�';3>}•'>•_ ;.5'':.^'_ -�:M1s: -- - :_.�...,..;.?G�'��7�'?�'b�•:.r' `:.,�: �i ,.-'•�'�� , «y,�;' "w. ,,..+v y., .»,...y1� »�.II.����'�••�:i".+d P .t�lE��l�at r�.�°h'(W:yi~. <•a✓<.�7adr;"'.'�',;Y;H' :_.» :�,z_ �x � ..., .t }' ";..LM 4'4" :Cs. . ''','IV:1, ; • ;' '•.;`r 't,i� , €(1.'rri� ) • � ''r4= " ms"° 34,114x; r �4 21I .1 n, ''01:1 1i• + '4. "'i'."'"�.&r'Sy iy^:-:•=''.`•ra1.+,•: 1 ` .. -.F:a� '•7Mkrr`;:� „ :4�:hj': 3. t .y� .......>rs..a. ,�,...�',i S+,T�,`_,,.r.:!#.nt3�P.:=.,' i3�.;..... ..::.+.r,.u;• r'j;,`r.;k':,"6,,i;'ks i ,h.,;itax,'i:,''L' - 4 .,�.W...:�.. awr"«;«., r.ru<•r..r;'.:<, •«,�.1Pti:: �,:'wyy,' :'^ '3 r,t,,. ,3�irrj»,,;�• • -• .:-i :•t'' .r�'�:1,: "r Apr• ,fin' •y ev'� 1 •M�3' :P.-'`xi. m.. :,,,."• �." ..„ 3i s:''o�- �.;F•ai, ..t' ;.x.�i' _a 'E, ('.1�[ars3- ,1`[Q-�:».... y �' .�'' :�'..I. "4£t•�o. .i�. , ..:i?,:.: W_ .:�';>i'ra•'�a:i,r�`4it«,�7•���;; r :r �, „ �i ....7..;r ''f •-= - �• :;, „-',a>:,,:•»:,,>;:i':;:cr, ,s ti- g. ,,� • . :•. . '� +: 1.�3y 2?!•Iw,r ;` '• , f:.,.. st wT'r;«,ci*K, •'�e,,.�aaa���``F'�k�::3r:.;�,r`ai�< '€'r� 'k: „•.�� ,-�€� �:'�'V ` _ _. • =•::t;'.:c,.•'.r'�rt`:r_ ..�. "��+"��w •�... i`-t`,^;i� :,�:.y-::' ;Cr- - .,tr.�>a-, .e� ,' La ti":v •o':t •.i+�s:«3:.` s, •a. : •�.�ai..> - .?;' _ - - ;,_ >t,�isd�F»�4'�i'�• 1, . t. ,y i„..fli ,F��`.#,fFf..l�;41:1 E7 n.it�7:�3 r� tY •�i'- ? - - $ i . , at . it sd:,:;= s:•w's.F:rE Tj v� ..—.._........_�._• .__ .'f.:, .....•,Et'...Y^�`..u.+ ... h 1}'� `.r.FWui.....•'i"'rlu •........1r._ •. .i.Y' ''2''� L» 's•i: PLEASE PROVIDE THE FOLLOWING: I:41 Name of family member who resides on-site&operates child care: J62zm,`L QeS� ❑ Copy of license from the Dept of Social&Health Services: ❑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). ESI How many people living outside your home will be working at the child care: NE ❑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 1,2007 Page 1 of 4 k:\Handouts\In-Home Child Care Application 41. • v .• .5 .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): b Yes 0 No 11. Do the sleeping or napping rooms have a door directly to the exterior of the building: ,laKes 0 No 12. Do any commercial uses occur next to the child care area: ❑Yes ,13/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 ❑No 0 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 ❑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. Josez 3)40/(1 .CA 's a_ Full Printed Name 42azyck.3- //t/0 ?- Signature Date • Planning Representative Date Building Division Representative Date Bulletin#029—January 1,2007 Page 3 of 4 k:\Handouts\ln-Home Child Care Application