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 11 PERMIT A Class 11 Permit allows a person operating a bed and breakfast lodging facility to donate or serve beer or wine without charge to overnight guests for consumption on the premises. A bed and breakfast facility is defined as a hotel or similar facility, offering one to eight lodging units and breakfast to travelers or guests. (WAC 66.20.010(11)) Permit Processing Information The annual application fee is $80. Make your check payable to WSLCB. The Class 11 Permit expires June 30th of each year. Renewal notices are mailed approximately 4-6 weeks before the expiration date. In addition to this application, first-time applicants are required to submit the following documents: 1. Your proof of ownership or use of property document. Examples would be a copy of your lease or a purchase and sale agreement. 2. A completed Personal/Criminal History Statement on the WSLCB website. Before we can issue your permit we must receive the following information from you. Please mail all documents to the above address. 1. The completed application. 2. The $80 check. 3. The proof of ownership or use of property. 4. The Personal/Criminal History Statement. Allow 30-45 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 Applicant's name Name of Corporation, Partnership or Limited Liability Company (if applicable) Mailing address (Street or PO Box, City, State, Zip Code) Contact person Phone: ( )Phone : ( )Title E-mail address: - This form is continued on the back page. American LegalNet, Inc. www.FormsWorkFlow.com LIQ 391 7/15 Page 1 of 2 APPLICATION FOR CLASS 11 PERMIT ­ continued Business Location Information Business name Location address (Street or Route, City, State, County, Zip Code) Inside the city limits? Yes No Type of business (include how the alcohol will be served, for example, with breakfast, in room, etc.) The number of rooms available : 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. I also understand that it is my responsibility to notify the WSLCB of any and all changes in ownership or use of property. Print Name: Signature: Title: Date: American LegalNet, Inc. www.FormsWorkFlow.com LIQ 391 7/15 Page 2 of 2