Licensing and Regulation PO Box 43085 Olympia, WA 98504-3085 Phone: 360-664-1600 Fax: 360-753-2710 www.lcb.wa.gov For Office Use Only Date: Check #: Amount rec'd: Rec'd by: License #: APPLICATION FOR CLASS 1, 2 OR 6 PERMITS Choose one of the following permits Class 1 Permit - $5 fee (RCW 66.20.010(1)) The Class 1 Permit allows liquor to be purchased by a physician or dentist or any person in charge of an institution such as a hospital or sanitarium or a home devoted exclusively to the care of aged people. Class 2 Permit (choose one of the following fees) $5 fee to purchase 5 gallons or less or (RCW 66.20.010(2)) $10 fee to purchase over 5 gallons The Class 2 Permit allows liquor to be purchased by a person engaged in a mechanical or manufacturing business, or in scientific pursuits requiring alcohol. The use of alcohol for beverage purposes is prohibited. There is no fee for city, county, state or federal institutions or accredited education institutions. Class 6 Permit - $5 fee (RCW 66.20.010(6)) The Class 6 Permit allows liquor to be purchased at retail by a person operating a drug store and who then sells the liquor on the prescription of a physician. Permit Processing Information Please make your check payable to WSLCB. The Class 1, 2 and 6 Permits expire June 30th of each year. Renewal notices are mailed approximately 4-6 weeks before the expiration date. Mail your completed application and check to the above address. Allow 7-14 business days for processing. Your permit will be mailed to you. If you have questions, please call Customer Service at 360-664-1600. Applicant Information Business name: Business address (Street or Route, City, State, Zip Code) Mailing address (if different from above): Person representing business Type of business: How will the liquor be specifically used? What is the approximate amount of liquor required for the current fiscal year? I declare under the penalties of perjury that the answers contained in this application are true, correct, and complete. The undersigned certifies it is understood that a misrepresentation of fact is cause for rejection of this application or revocation of any permit issued. Print Name: Signature: LIQ 354 6/17 Phone: ( )- - E-mail address Title: Date: American LegalNet, Inc. www.FormsWorkFlow.com