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c , � <br /> Inetructions Iw OriOinator . � <br /> 1. Thie lorm fa to be ueed upon reeNpt ot en application for a day c. center, mini-dey care center, or proup cere facility lor <br /> chlldren. � , <br /> 2. k is unnecesaery to uee this form lor reliceneinp unless there le elao e chenpe o1 �ddrees for the Iecllity. <br /> 3. One copy ot the completed lorm shell be(orwerded to the appropriete local plannfnp/zoninp apency, one to the eppAcent, <br /> and ona copy nhall be pleced in tho liceneinp file. � <br /> 4. For dey cere centera e copy shell elso be forwerded to: <br /> i <br /> Chief Boiler Inepector � <br /> Depertment of Lebor and Induetriea � <br /> 300 West Hertieon, Room 608 <br /> Seattle, Waehinpton 98719 <br /> I <br /> II <br /> I <br /> � <br /> DSHS 15�1l5(R�v. J/ES)B�M 0%A.GO <br /> � <br />