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 Permit:#: Date: Amount rec'd: Initials: APPLICATION FOR CLASS 5 PERMIT The Class 5 Permit allows a manufacturer to import alcohol, malt, and other materials containing alcohol to be used in the manufacture of liquor or other products. (RCW 66.20.010(5)) Permit Processing Information 1. 2. 3. 4. 5. The annual application fee is $10. Make your check payable to WSLCB. The Class 5 Permit expires June 30th of each year. Renewal notices are mailed approximately 4-6 weeks before the expiration date. Download and fill out the front and back of this application. Mail your completed and signed application and a $10 check to the above address. Keep a copy of this document for your files. 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): Type of business: Contact person: Email address: Phone: ( )- This form is continued on the back page. LIQ 288 6/17 American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 2 Application for Class 5 Permit continued Business Information State the specific purpose for which the material below is to be used: In the table below, list the approximate amount of each material required before the June 30th expiration date. The types of alcohol required. The total quantity of each material in gallons or other measure that is required annually. The maximum of each material desired to be purchased at one time in gallons or other measure. The name of your supplier and shipping point 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: Title: Date: LIQ 288 8/15 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2