1987, 09-21 Receipt of App to Provide Child CareTO:
FROM:
wgle+GXr1 STATE
DEPARTMENT OF
SOCIAL &FEAR
SERVICES
Janes L. :lanson , Director, Spokane Cou:ty "ui 1 di ng Codes
North 811 Jefferson, Spokane, WA 99221
Rey R. Harrington, Regional Administrator, Division of Children and Family Services,
Region 1, T^.F C-38, C32-21, Spokane, WA 9922C
SUBJECT: RECEIPT OF APPLICATION TO PROVIDE CHILD CARE
This is to inform your office that we have received from:
NAME
STREET OR BOX NO.
99216
CITY
an application to establish a
s Day Care.
TYPE OF FACILITY
at sac+ 11209 — 6th Avenue
STREET
1'A
ZIP CODE
for - children
CITY ZIP CODE
We will be acting on this application within 90 days of receipt.
While this department does not assume any responsibility for the enforcement of local ordinances, including those pertaining to
zoning, land use permits, etc., we have advised the applicant to contact your agency regarding your requirements.
If your office is not responsible for zoning, land use permits, building code, etc., please forward this notice to the appropriate
agency.
/1, iv 12,4 9 -P1-4 7
See Instructions on Reverse
DSHS 15.165 (Rev. 3/85) OX A-90
Instructions for Originator
1. This form is to be used upon receipt of an application for a day care center, mini -day care center, or group care facility for
children.
2. It is unnecessary to use this form for relicensing unless there is also a change of address for the facility.
3. One copy of the completed form shall be forwarded to the appropriate local planning/zoning agency, one to the applicant,
and one copy shall be placed in the licensing file.
4. For day care centers a copy shall also be forwarded to:
Chief Boiler Inspector
Department of Labor and Industries
300 West Harrison, Room 506
Seattle, Washington 98119
DSHS 15-165 (Rev. 3/85) Back OX A-90
nTDEPARTMENT OFSERVCES
TO:
James L. Manson, Director, Spokane County Building Codes,
N. 811 Jefferson, Spokane, WA 99201
FROM: Roy R. Harrington, Regional Administrator, Division of Children and Family Services,
Region 1, TAF C-38, B32-21, Spokane, WA 99220
SUBJECT: RECEIPT OF APPLICATION TO PROVIDE CHILD CARE
This is to inform your office that we have received from:
Shirley Bartle
"J
NAME
East 1320.9 - 6th
STREET OR BOX NO.
Spokane, WA 99216
CITY
an application to establish a
ZIP CODE
BARTLE' S DAY CARE for 12 children
TYPE OF FACILITY
at East 13209 - 6th
STREET
Spokane, WA
CITY
We will be acting on this application within 90 days of receipt.
While this department does not assume any responsibility for the enforcement of local ordinances, including those pertaining to
zoning, land use permits, etc., we have advised the applicant to contact your agency regarding your requirements.
99216.
ZIP CODE
If your office is not responsible for zoning, land use permits, building code, etc., please forward this notice to the appropriate
agency.
See Instructions on Reverse
DSHS 15-165 (Rev. 3/85) OX A-90
Instructions for Originator
1. This form is to be used upon receipt of an application for a day care center, mini -day care center, or group care facility for
children.
2. It is unnecessary to use this form for relicensing unless there is also a change of address for the facility.
3. One copy of the completed form shall be forwarded to the appropriate local planning/zoning agency, one to the applicant,
and one copy shall be placed in the licensing file.
4. For day care centers a copy shall also be forwarded to:
Chief Boiler Inspector
Department of Labor and Industries
300 West Harrison, Room 506
Seattle, Washington 98119
DSHS 15-165 (Rev. 31tl5) Beck o% A-90