19523 84TH AVE W (2)5-2 FIRE PREVENTION
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SNOHONTISH CO. DEDMONDS
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BUSINESS NAME: Maplewood Childcare/Preschool
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SNOIHOMI'SH'CO.
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www.FireDistrictl.org
FIRE PREVENTION
124.125 Meridian Ave S INSPECTION REPORT
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FIRE DEPARTMENT COPY
FIRE PREV,ENTION
Serving Brier Edinonds
12425 Meridian Ave S
INSPECTION, REPORT
SNOHOMISH CO.
FIRE
Mountlake Terraceand
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PHONE: 4257769-1164
SCHEDULED 11/01/12
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FIRE DEPARTMENT COPY
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Serving Briei; Ednionds
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FIRE
the Town of Woodway
DISTRi4�T www.FireDistrictl.org
LOCATION: 19523 84th Avenue
BUSINESS NAME: Maplewood Childcare/Preschool
MAILING 19502 34th Av W
ADDRESS: Edmonds
BUSINESS OWNER: Maplewood Childcare
EMERGENCY-1: Keating, Beny
KEY ACCESS-2:
PERSON CONTACTED
NAME OF INSPECTOR
FIRE
SYSTEMS:
W
12425 Meridian Ave S
Everett, WA 98208 -
Phone (425) 551-1200
Fax (425) 551-1272
PHONE: 4257769164
98026
HOME PHONE: 4257769164
HOME PHONE: 4257455806
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
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DATE:
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LETTER NEEDED C] YES [] NO
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FIRE DEPARTMENT COPY
Westfall, John
From: Westfall, John
Sent: Thursday, February 15, 2007 1:45 PM
To: 'Bullis, Ann'
Subject: Maplewood Presbyt Child care
Ann:
Anything else you need here?
Below is the DSHS search engine used.
John
MAPLEWOOD PRESCHOOL - Data current as of 02/14/2007
19523 84TH AVE WEST
EDMONDS, WA 98026
; (425) 778-5248
License ID
Facility Type
Initial License Date
Last Renewal Date
License Expires
109457 Licensed Ca�acitv 12 children
Child Care Center Ages Served From 12 Months To 5
Years
1/9/2007 Current License Status Initial
Licensor Frances Conrad
7/8/2007
Licensor Phone (425) 438-4826
Complaint history alone does not reflect all the important factors that should be considered when choosing child
care for your family. The parent resource vage has additional information about choosing quality child care.
DEL receives an average of 3 100 complaints each year. Only 3 0% have at least one valid issue.
Valid Complaint History after July 24, 2005:
There were no complaints with valid issues since July 24, 2005
Inconclusive Complaint History after July 24, 2005:
There were no complaints with inconclusive issues since July 24, 2005
To get more information about this provider, including any complaints that may have been resolved
prior to July 24, 2005, please call 1-866-482-4325 and request information about License H)# 109457
Search engine:
https://fortress.wa.gov/dshs/f2ws03esaapps/iccis/Iccis.asp
inBASEMENT PLAN �;,%
S..W. 1/4* qN P 2,N�o 7
GARY HAAKENSON
CITY OF EDMONDS MAYOR
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 FAX (425) 771-0221
Website: www,ci.edmondswa.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
December 11, 2006
Pastor Keating
Maplewood Presbyterian Church
1952384 1h Avenue West
Edmonds, Washington 98026
RE: Maplewood Presbyterian Day Care Center
Dear Pastor Keating,
The purpose of this letter is to reiterate the requirement to obtain a building permit for the minor
remodeling that has occurred in the Day Care Center area of the Church. For your convenience I
have enclosed the City's handout that describes the plans and details needed in order for the City
to approve a remodeling permit.
Please be assured the State adopted Building and Fire Codes are minimum requirements for the
entire State of Washington. The purpose of these codes is to provide minimum life -safety
standards to protect people, buildings and property. The requirement to obtain a permit; the
requirement to have plans stamped by a State Licensed Professional Engineer or Architect; are
applicable in every jurisdiction within the State. The City is not requesting any more of the
Church than any other private or public business.
Because the Day Care Center houses the most protected class of people within the code
(children) my office must insist that you submit for the required building permit approval by
January 3, 2007. If there are circumstances beyond the Church's control. that will prevent a
complete application and plans from being filed by this deadline please contact my office in
writing and include an alternate date of submittal.
If you have any questions please feel free to contact John Westfall, Fire Marshal (425-771-0215
extension 1213) or myself during City business hours of 9:00am to noon and 1:00pm to 4:00pm,
Monday through Friday. When you come to City Hall to submit for the permit please ask for
Theresa Umbaugh, Permit Coordinator as she is already familiar with your project.
Sincerely,
00"T
Jeannine L. (36af
Building Official
Cc: John Westfall, Fire Marshal
Incorporated August 11, 1890
Q;�+ t-;+,, 14-1,; T
Hey Paul! 19523 84th Ave W #A '
Page I of I
Westfall, John
From: Pau I.Schroer@wsp.wa.gov
Sent: Sunday, December 10, 2006 6:03 PM
To: Westfall, John
Subject: RE: Hey Paul! 19523 84th Ave W #A
John,
I am going to be in Monroe on the 11 th. Can you please page me at 1-800-409-0577 and we can talk.
Paul
From: Westfall, John [mailto:Westfall@ci.edmonds.wa.us]
Sent: Tuesday, December 05, 2006 14:28
To: Schroer, Paul (WSP)
Cc: Smith, Mike
Subject: Hey Paul! 19523 84th Ave W #A
Re: Maplewood Presbyterian Church Daycare Center, 19523 84th Ave W #A Edmonds, 98026
Paul:
I have another daycare going in and have had discussions with Precision Alarm for a system installation
that (State FM) was requiring (unless they reduce their daycare area). I've heard no more on fire alarm
and my building department wants to make sure they don't do the layout changes without permits.
Can you fill me in any with this one?
Thank you,
John
12/11/2006
Westfcill, John
From: Umbaugh, Theresa
Sent: Friday, December 08, 2006 2:02 PM
To: Westfall, John; Graf, Jeannine
Subject: RE: Maplewood Presbyterian Daycare Center
FYI ... I called and spoke with Pastor Keating. I stated that a permit is required for the work that was performed. He wanted
to know why the State Fire Marshall didn't tell him that a permit was required. I stated that the State Fire Marshall is most
likely familiar with the Fire Code and not the Building Code.
I stated that 2 sets of plans and 2 section views of how the closet was constructed, drawn by a WA state licensed Architect
or Engineer are required for review in order to issue a permit. He said the church doesn't have those plans, this building
has been here for a long time. I stated that the church would need to go to an Arch or Eng and have plans drawn to
submit for review. He asked why do the plans have to be signed by an Arch or Eng, I stated State law requires that all
buildings over 4,000sf in floor area are required to have plans stamped/signed by a WA state licensed Arch or Eng. He
stated that the area was only 1,000sf. I stated the requirement wasn't based on the area in question but the overall floor
area of the entire building the area is located in. He stated that somebody must have an awful lot of time on their hands in
order to enact a law like that.
Pastor Keating stated he would need to meet with the Church board in order to determine what they would do. I also
stated that it was my understanding that the closet was built in order to reduce the size of the room to negate the
requirement of a fire alarm installation. He said no, it was a size issue. I stated that if they decided to demo the closet that
a permit would be required for the demolition as well as a permit for the then required Fire Alarm He also asked what
would happen if no permit was obtained. I stated it could possibly be turned over to code enforcement.
Theresa M. Umbaugh
Permit Coordinator
Development Services Department
City of Edmonds
Hours M-F.- 9am-12pm and 1pm-4pm
(425) 771-0220
----- Original Message -----
From: Westfall, John
Sent: Friday, December 08, 2006 11:44 AM
To: Umbaugh, Theresa
Cc: Spellman, Jana; 'Bullis, Ann'
Subject: FW: Maplewood Presbyterian Daycare Center
OTheresa:
I'm apparently wearing out the welcome with the daycare center folks. Will you contact Pastor Keating directly
to reiterate and guide him through the permitting process? Please contact same # (press 4) or his home
phone is 425 745-5806.
Thank you,
John
----- Original Message -----
From: Westfall, John
Sent: Thursday, December 07, 2006 3:02 PM
To: Umbaugh, Theresa
Cc: Bullis, Ann
Subject: Maplewood Presbyterian Daycare Center
Theresa:
I told Barbara at the preschool/daycare center today that you would contact her with information about the
creation of a closet that will reduce the daycare center are to a point that will not require a fire alarm system
per the WA State Fire Marshal.
Please contact her at 425.778.5248 (press 5) to guide her with City needs on the project. Thank you
John
Westfall, John
From:
Westfall, John
Sent:
Tuesday, December 05, 2006 2:28 PM
To:
Paul Schroer
Cc:
Smith, Mike
Subject:
Hey Paul! 19523 84th Ave W #A
Re: Maplewood Presbyterian Church Daycare Center, 19523 84th Ave W #A Edmonds, 98026
Paul:
I have another daycare going in and have had discussions with Precision Alarm for a system installation that
(State FM) was requiring (unless they reduce their daycare area). I've heard no more on fire alarm and my
building department wants to make sure they don't do the layout changes without permits.
Can you fill me in any with this one?
Thank you,
John
12 �(, /,-C F" ,- 6 fft-�5 eczz--I�,C�50
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Page I of 2
Westfall, John F7- e:L4 f 6 LA.)l
From: Bullis, Ann 4`7 C44-6
Sent: Wednesday, November 22, 2006 10:17 AM
To: Westfall, John
Cc: Graf, Jeannine; Smith, Mike
Subject: RE: MapleWood day care & Luth Church Fire Alarm
John,
On 11/16/06 1 left a message for Ellen Kalmen, ECC, asking that she return my call and reminded her that permits are
required whether they decide to install a fire alarm or reduce/alter the floor area of the daycare to not have to install the fire
alarm. I have not heard back from her, but since the State Fire Marshal is requiring the fire alarm, would you be willing
for follow up in the near future to see what the State FM ends up approving so we can make sure permits are obtained?
Thanks,
Ann Bullis
Assistant Building Official
City of Edmonds
(425)771-0220
bullis@ci.edmonds.wa.us
----- Original Message -----
From: Westfall, John
Sent: Tuesday, October 03, 2006 2:07 PM
To: Smith, Mike; Bullis, Ann
Subject: FW: MapIeWood day care & Luth Church Fire Alarm
To file: Maplewood Presbyterian Church Daycare 19523 84th Ave W "A"
WA State is asking that the church provide an auto fire detection system in the daycare lower level. Edmonds FID is
requiring that the min. coverage include the items below with notification throughout. The sanctuary need not be
detected but manual only. The building is unsprinklered.
A permit is required.
----- Original Message -----
From: Dennis Lane [maiIto:dennisl@firesystemswest.com]
Sent: Tuesday, October 03, 2006 1:58 PM
To: Westfall, John
Subject: MapleWood day care & Luth Church Fire Alarm
John,
Per our phone discussion today, I will propose the following design to the owner for their fire alarm
system:
Lower floor:
1 . Smoke Detectors in day care area, exit hall, furnace room (if environment is acceptable other
wise, heat det.), and class room.
2. Heat detectors in kitchen, and restrooms
3. Pull station at stair exit and grade level exit from day care.
4. Horn strobes in day care area, exit hall.
5. Strobes in class room and both restrooms
6. The fire alarm control panel will be located in the furnace room if environment is acceptable.
Upper Level:
1. Smoke Detectors in the Narthex, class rooms and Pastor's study / offices.
11/22/2006
Messa�-,Q Page 2 of 2
2. Horn strobes in the Sanctuary, class rooms, and Narthex.
3. Strobes in the restrooms.
4. Pull stations at all designated exits.
5. Remote annunciator at designated fire department entry.
6. Fire alarm system to be Monitored by UL listed central station.
I will verify that the plan I have been using is accurate to what actually is being used. There may
be a few changes — because I remember seeing some offices that are not shown on the drawings.
I will keep you updated on this.
Thanks,
Dennis Lane
Precision Alarm
P.425-697-2116 Ext #109
F.425-697-215�
Den.nisL@firesystemswest.com
PrecisionalarmlIc.com
NOT I F 10�111W
FIRE -S-Y'STEMS
11/22/2006
Message
Page I of 2
Westfall, John
From: Westfall, John
Sent: Thursday, October 05, 2006 8:46 AM
To: 'Bullis, Ann'; Smith, Mike
Subject: FW: MapleWood day care & Luth Church Fire Alarm
FYI
----- Original Message -----
From: Dennis Lane [mailto:dennisl@firesystemswest.com]
Sent: Thursday, October 05, 2006 8:37 AM
To: Westfall, John
Subject: RE: MapleWood day care & Luth Church Fire Alarm
John,
It appears that the owner has had a change of direction on this project.
They have decided to modify the day care part of the facility to get under the square footage rule that
brings in the state required fire alarm system for that space.
They apparently will not be doing any fire alarm work in the building at this time.
Thanks for your help. If was good to speak with you and get a better understanding of fire code
application in the city of Edmonds.
Regards,
Dennis Lane
Precision Alarm
425-697-2116- # 109
From: Westfall, John [mailto:Westfall@ci.edmonds.wa.us]
Sent: Tuesday, October 03, 2006 2:08 PM
to: dennisl@firesystemswest.com
Subject: RE: MapleWood day care & Luth Church Fire Alarm
Dennis:
I don't want to assume but a fire alarm permit is required.
Thank you,
John
----- Original Message -----
From: Dennis Lane [mailto:dennisl@firesystemswest.com]
Sent: Tuesday, October 03, 2006 1:58 PM
To: Westfall, John
Subject: MapleWood day care & Luth Church Fire Alarm
John,
Per our phone discussion today, I will propose the following design to the owner for their fire alarm
system:
Lower floor:
1 . Smoke Detectors in day care area, exit hall, furnace room (if environment is acceptable other
wise, heat det.), and class room.,
2. Heat detectors in kitchen, and restrooms
3. Pull station at stair exit and grade level exit from day care.
4. Horn strobes in day care area, exit hall.
10/5/2006
,�'Message
Page 2 of 2
5. Strobes in class room and both restrooms
6. The fire alarm control panel will be located in the furnace room if environment is acceptable.
Upper Level:
1 . Smoke Detectors in the Narthex, class rooms and Pastor's study / offices.
2. Horn strobes in the Sanctuary, class rooms, and Narthex.
3. Strobes in the restrooms.,
4. Pull stations at all designated exits.
5. Remote annunciator at designated fire department entry.
6. Fire alarm system to be Monitored by UL listed central station.
I will verify that the plan I have been using is accurate to what actually is being used. There may
be a few changes — because I remember seeing some offices that are not shown on the drawings.
I will keep you updated on this.
Thanks,
Dennis Lane
Precision Alarm
P.425-697-2116 Ext #109
F.425-697-2155
DennisL@firesystemswest.com
PrecisionalarmlIc.com
. F-I
10/5/2006
REPORTED BY OF
SUBJECT
ADDRESS:
CONCERNS/
HAZARDS:, -J-V� A _�7q - 0 W7
Mf
SIGNED
FoLLow-up:
SIGNED
Office of Fire Prevention
--,tee
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DEPAPTHENT OF �SOCIAL AND HEAL11i SERVICES
REQUEST FOR INSPECTION REPORT OF CHILD PARE. AGENCY
Date October 25, 1974
TO: STATE FIRE MARSHAL
HEALTH -SERVICES DIVISION x7.
inspection for conformity irith licensing requirements is requested for the following -
Day Care Center
Child C�Lre Institution
Maternity Home
Group Home
Name of Agency Happy Hollow Preschool
Address Maplewood Presbyterian Church 19502 84th Ave. West
Edmonds 98020
City Zip Code
Executive Mrs.. Barbara Bell
Telephone. 776-5493
Capacity:
25 boys and girls from 2 112 through 5 years,of age.
girls.,(and vomen) from through years of age.
boys from through years of age.
Current license expires or new agency x
back
Remarks: They are on the lower level go you heed to go around to the kukk of the
church. They operate only 9-4:00
(continue -on back of page if necessary)
'encies Unit
Services to,��ild Care Ag
Famil* and Children's.Services Section
Y
DSHS 10-37(6-73)
(10PA-1, 7)
WASHING116N
STATE
J-J.R E'
M H A L
TOMP ANn
LIFE
SAFE'L'Y
INSPiXTION
'i r E-
Building No. or name I . Marshal.
Classification -
inspected by,
(flame & Title) ate
D,
I -lame 6�0�-4001 P1"_-SFSC1-10C4
Address 9 S 0.2 - 7;1-1 11- Zip Code P90-Zo
0
City (:�_/0/110A/4>_5 County Telephone -7 2 93
Dire c tor/Operator Facility Fire Marshal
0— -
OCCUPP14CY �A B C D EJFJGJH I J
7
TYPE COUST.
HT, 1-hr, N
._�
2 Stories� wVwlo Basement. Area: IoDQ __pq. ft.
Automatic Sprinkler� Full Partial.
Dry Chem.System -------Co2 System
Fire Alarm:�Manual Smoke: F P Heat: F P
Local Fire Dept. zF,0,,T-7oA,1.o5
Year bldg. built & additions WATER: Municipal — Private i—/ Nearest Hydrant _20o ft
No.
I T E M
1 -.1 -
Meets e irements
. �'es N/A_No
1
2
3
4
5
6
7
8-
9
1.0
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
128
29
30Pas
Does the bldg. meet construction requirements? .................................
Are stairwells-&"vertical.shafts enclosed or -fire -stopped?.... ***"*** ... *
Are hazardous areas separated from other portions of the.bldg.? ..............
Are unoccupied attics sub -divided? ...... ......................................
Are corridors one -hour rated? .................................................
Are corridors free of obstr�uctions? ..................... .........................
Does interior finish of corridors & public areas meet current
flamespread requirements? ......................................................
Are floor coverings tested & certified as meeting DOC FF 1-70 for
surface flamma"pility? ............................... .....................
Are proper exits provided? ............................................. I .........
Are exits properly marked? ......................................
Do all exit doors open outward?.'..... . . . . . . . I . ..... . . . . . ... . . . . . .
Are all outside exit doors.easily ope a from the inside? ..................
n*Le
Are cooking units provided with hoods & filters? .................................
Automatic fire protection? .... Type ...... .........
Is automatic fire detection system.tested, inspected &'certified at
least annually? Date by whom ...........
Is automatic fire detection system erconnected to,�he manuaT fire
alarm system? ......... Fire -Dept.. ......... .............
Is automatic sprinkler system tested, -inspected & certi d at
least annually?..Date _____�by whom
Is the automatic sprinkler system electrically interconne-cted to -the,
manual fire.alarm system? .... Fire Dept. ...................
Is the automatic sprinkler main valve electrically
Is proper clearance maintained around sprinkler -heads? ........................
Is sprinkler piping & valves free of obstructions?.,..,. .........
Is a fire department connection provided? ... Accessible & not obstructed?...,.,
Is outside bell provided: Electric water motor . ........................
Are operating instructions, spare heads & wrench located adjacent to
the�main controlvalve? ........................................... I ............
Is proper,fire extinguisher coverage provided? ....... * ... ** .............
Have fire extinguishers,been serviced within.the past year?..� ... .............
Date by whom
Are all areas proviaed with manual fire alarm boxes & warning devices? .......
Is fire alarm system electrically supervised? ....................... ......
Connected directly to the fire dept.? How? . . ... . . . .
Is fire alarm tested at regular intervals & records kept? .......
Is an emergency generator provided? KW Fuel ..... ...
comprehensive Fire-& Evacuation Plan been entablished?
_V
I/
V
7
V/
V
__V
V
I T E M
, J Y e e V .............
ropies of Fire & Evacu ation Plan available to all empl_,._,ye�
Ar� periodic training sessions held for all einployceS &.records Xept?.
(Date, time, subject, those attending,, etc.)
Is fire safety included as a part . of new employee indoctrination? -
Have all employee s received training in the actual Lise Of fire I .............
extinguishers and hoses? .......................................
Are adequate fire exit drills held? ............. ............................
ate in drills & training sessions? ..........
Does the local fire dept. particip , C,
Does the lobal fire dept. make at least annual inspections & furnish
Written copies of their findings? ................................. 4 .....
re 5moking regulations established & e.nforced9 ..............................
n areas where smoking is allowed, are suitable ash -trays provided? ...........
Are "No Smoking" signs provided in prohibited areas? .................
Are draperies, curtains & other similar decorative effects of fire -
resistive material or flame -proof treated? ............................
Is rubbish stored & handled safely? ...........................................
Is housekeeping in all areas satisfactory? .......................... * ........
e storage methods satisfactory? .......................................... '
Is all equipment and fixtures in good repair? ................................
Vre.electrical cords in good repair and properly used? .............
J
32
33
34
35
30"
J)7
38
39
40
41
42
43
44
45
46
...
. I/
)I/--
.
V
.
DETAILS: (Use form S.F. 470 for requirements
Additional details attached
_JLimitations & Restrictions
Sketch or* Plan Photos Other 1__/ Ivo"-,f
ocation - approved: L--Jno
By (name & title)
eDort revieweii by (nain4_& title)
ire Marshal Approval Granted: L--Jyes L_/no L__JCertificate L
By (name & title) Date
indings forwar�ed to requesting agency: Date —By
ollow-4 required: L_Iyes /no
Within days. Copy to area deputy on
date
�rq 0;
ter!
SEND ALL REQUESTS TO:
office of State Fire Marshal
Inspection Division
Insurance Bldg.
WASHIN TON STArM FIRE )NIARSHA4
INSUR.-MUE HPIA, WA 98504
FIRE & LIFE SAFETY INSPECTION
Date 7
.................
Property'Inspected ........ ...... ................................................................... ............
Inspected.. .................. ...................
(� Reinspection. Date ... ..................... .................. ....... ................
....................... ... ... ... . . ........................
Item, Description, Location Correction Required Date
-;2
�y
The described deficiencies have been explained to me and I a&ee
to correct by the dates indicated.
Signed............................................................................................... ..............
Owner, Operator.
S. F. 470--05.
Fire Protecdon Services Division
DEPARTMENT OF COMMUNITY DEVELOPMENT
CHILD CARE AGENCY FIRE & LIFE SAFETY INSPECTION
AGENCY NAME bliX 0051 Ch 11 14 Ca Kt* —
PRONE
29s!*W 0
4..CDUNTY
Ir five 22"'tl �Lo
),�L
STREET ADDRESS C ITY ZIP CODE
LICENSEE: &3 40ME L e-
t
INSPECTED,BY
C *,— .7
RESIDENTIAL INSPECTION SECTION
FIRE PROTECTION SERVICES DIVISION
L MAILING ADDRESS
CIS' !A& - 9?0,�_o INSPECTED ON, 2,Y sl—U
CITY STATE ZIP CODE
INITIAL INSPECTION REINSPECTION NO. TYPE AGENCY
9
P� .. 4
No
ITEM
MEETS
REQUIREMENTS
FLJ,�!W CARE CENTER ''R DAY CARE CENTER
NON -RESIDENCE IN -RESIDENCE
MINI DAYSCARE MINI DAY CARE
N ON- RESIDENCE IN -RESIDENCE
EJ: GROUP CARE
FACILITY MATERNITY
SERVICE
DAY TREATMENT GROUP CARE
PROGRAM FACILITY FOR
SEVERELY AND
JUVENILE DETENTION MULTIPLE
FACILITY HANDICAPPED
E]OTHER:'
YE§,,-
NO
N/A
I
NUMBER OF EXITS
2
EXIT SEPARATION
3
TRAVEL DISTANCE TO EXITS
4
BASEMENT EXITS'
5
EXIT DOORS
6
EXIT, DIRECTIONAL SIGNS
%1001
7
EXIT PATHWAY L IGHTING
8
EMERGENCY LIGHTING-
'9
EXIT OBSTRUCTIONS
to
SAFE DISPERSAL AREAS
11
OCCUPANCY SEPARATIONS
12
STAIRWAYS, EXIT ENCLOSURES
13
OTHER VERTICAL OPENINGS
14
i5
CORRIDOR CONSTRUCTION
CONFERRED WITH:
NAME: 71 %Ir 13
16
17
INTERIOR FINISH;
. , r — .
,TITLE:
I . 81
SLEEPING ROOM WINDOWS
191
SLEEPING ROOM DOORS
�.IMA
TE _R
INALS Pi OVIDED*
C.
opyofinsp.Rept._1t=_ FPSForm221
Self AdI:lressed Env. 'FPS Fo' I rm 222
Status Report FPS Form 223
Fire Emer. Plan FPS Form 226
FPS Bulletin No. WAC 212.14
F S Bulletin No. WAC 212-54
FPS Bulletin No. WAC 212-55
FPS Bulletin No. WAC 212-64
FPS Bulletin No.— WAC 212-65
FPS Bulletin No. WAC 212-70
FPS Bulletin No. Fire Ext. Report-
OTHER:
20
MANUAL FIRE ALARM,
21
AUTOMATIC DETECTION SYSTEM
22
SINGLE STATION SMOKE DETECTORS
23
24
AUTOMATIC SPRINKLER SYSTEM
25
RANGE HOOD EXTINGUISHING SYSTEM
26
27
CONTROL OF HAZARD CONDITIONS
28
FIRE EXTINGUISHERS
29
30
OVERNIGHT DAY CARE CENTERS
31
STAFF RATIOS
32
33
FIRE EVACUATION PLAN
34
FIRE DRILLS, RECORDS
Loll
35
36
MAINTENANCE
Vol'
Other Details:
WHITE COPY —Fire, Protection Services Division PINK COPY—DSHS Licensing File
FPS FORM 204 (3/88) -1365- -901- 3 CANARY COPY —inspector GOLDENROD COPY —Licensee/ Facility Copy
RIGHT OF APPEAL
Chapter 48.48.050(2) of the Revised CodeF6f_Wasfiirigton Vov-i'dias an- a_p�0e_a_I'p-roc-es_s_fo_r -owneirs
or occupants aggrieved by the corrective orders of the Director of Community Development,
through the Director of Fire Protection or his or her deputies. The referenced section states: -
"An owner or occupant aggrieved by any such order made by the dirictor of-c6mr6briffy
development, through the director of fire protection or his or her deputy, may appeal
such order pursuant to Chapter 34.04 RCW. If the order is confirmed, the order -shall
remain in force and be complied with by the owner or occupant."
Should you elect to appeal a corrective order made by the Director of Community Development,
through the Director of Fire Protection or his or her deputies, you must file a written request for a
hearing. The request for hearings,hould be forwarded to:
Director
Fire Protection Services -Division
Department of Community Development
9th & Columbia Building. GH-51
Olympia, Washington 98504-4151
Upon receipt of the request for a hearing, the Director will promptly advise you of the date and
time of the hearing. The hearing will be before the birector or his/her designee and, absent
extraordinary circumstances, will be conducted in Olympia.
At. the hearing you are entitled to be accompanied by_counsel, may present evidence and test-
imony, and you may call witnesses. The hearing will be limited in scope to a review of the proprie-
ty of the corrective order appealed from; it will not -involve the legality of the fire/life safety
regulation (WAC) pursuant to which the original order was issued.
Should the Director confirm the corrective order in question, the order shall remain in force, and
notification to that effect will -be forwarded to the Depariment of Social and Health Services.
Should the Department of Social and -Health Services take action relative to your license, which
you do not agree with, you will then be afforded an opportunity for a formal hearing, pursuant to
the Administrative Procedures Act, Chapier 34.04 of the Revised Code of Washington.
2048 (3/88) -1365-