Regulatory Services Division PO Box 43085 Olympia WA 985043085 FAX 3607532710 wwwliqwagovCheck No Amount Rec146d Rec146d by Application for Class 10 Permit 30 Fee Applicant Informati ID: 884767
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1 For Office Use Only Regulatory Services
For Office Use Only Regulatory Services Division PO Box 43085 Olympia WA 98504-3085 FAX 360/753-2710 www.liq.wa.gov Check No. Amount Rec’d Rec’d by Application for Class 10 Permit $30 Fee Applicant Information Name of Applying Manufacturer, Importer, or Wholesaler (First, Middle, Last) Title Telephone No. ( ) Event Information Name of Entity Sponsoring Event Sponsoring Entity is a: Government Entity Nonprofit Organization Type of Event (Hall or Building,, Street, City, State, Zip Code) Hours Liquor Will be Served From: To: Type of Liquor to be Served Beer Wine Spirituous liquor Name (please print) Signature Date If you have any questions or need assistance, please call (360) 664-1641 LIQ 039-1/10