Application For Class 4 Permit {LIQ 651}

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 4 PERMIT The Class 4 Permit allows a business that does not hold a liquor license to serve liquor without charge to employees or invited guests. The liquor must be purchased at retail. The liquor service cannot be advertised. The liquor must be served in specified hospitality or dining rooms. The general public may not be allowed in these rooms while liquor is being served. The liquor cannot be sold in any manner including by scrip, donation or contribution. Guests may not be charged for admission to the hospitality or dining rooms or for any meals or services provided in the rooms. Liquor may not be served more than 24 hours during any weekly (168 hour) period. No other liquor license may be in use at this location. (WAC 314-38-010) Permit Processing Information 1. 2. 3. 4. 5. The annual application fee is $500. Make your check payable to WSLCB. The Class 4 Permit expires June 30th of each year. Renewal notices are mailed approximately 4-6 weeks before the expiration date. Mail your completed and signed application and $500 check to the above address. 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 Business name: Business address (Street or Route, City, State, Zip Code) Business type: Inside city limits Yes No Mailing address (If different from above) Phone: ( )­ - List the locations and describe the rooms where liquor will be served: This form is continued on the back page. LIQ 651 6/17 American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 2 Application for Class 4 Permit -continued Corporate Information Partners, Officers or Limited Liability Company (LLC) Members/Managers Attach additional sheets if necessary. Name Home address (Street, Route or PO Box) City Title State Zip Code Birthdate: Phone: Name Home address (Street, Route or PO Box) Percentage of business owned: ( )- % E-mail address: Title City State Zip Code Birthdate: Phone: Name Home address (Street, Route or PO Box) Percentage of business owned: ( )- % E-mail address: Title City State Zip Code Birthdate: Phone: ( )- Percentage of business owned: E-mail address: % 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 651 6/17 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2