Fillable Printable Home Inspector License Application
Fillable Printable Home Inspector License Application
Home Inspector License Application
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Home Inspector
License Application
You can use this form to apply for a home inspector license.
Send this completed form to:
Home Inspector Program
Department of Licensing
PO Box 3917
Seattle WA 98124-3917
Please include the following:
• A check or money order for $680, payable to the Department of Licensing
• Copy of your passing document from the testing center
Applicant information
TYPE OR PRINT Name (Last, First, Middle initial) Social Security
number required
*
Mailing address (Number, street, and suite or room number)
City State ZIP code
(Area code) Daytime telephone number (Area code) Fax number Email Date of birth (mm/dd/yyyy)
Answer all of the following
If you answer “Yes” to any of these questions, attach a letter of explanation. Include the charge, date of conviction,
civil jurisdiction, state, and disposition of charges.
In this state or any other jurisdiction, are you are have you:
1. Within the last 10 years, had any action (fine, suspension, revocation, censure, etc.) taken against
any professional license, certification, or permit held by you?...................................
Yes No
2. Within the last 10 years, had any civil court order, verdict, or judgment entered against you? ..........
Yes No
3. Within the last 10 years, defaulted or been convicted of or entered a plea of no contest to a gross
misdemeanor or felony crime? (Don’t include traffic offenses) ..................................
Yes No
*All applicants are required by federal and state law to provide their Social Security number (SSN) for use in child support enforcement programs (42 U.S.C.
666(a)(13) and RCW 74.20A.320). It may also be used for education loan repayment programs and identification of records with similar names. Submission
of your SSN is mandatory; failure to submit it will result in denial of your application.
Applicant certification
If you provide false information on this application, your Washington home inspector license may be denied, suspended, or
revoked. If you do not comply with any provision of the Home Inspector Act or any rule or regulation, your license may be
suspended or revoked.
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
Date and place Applicant signature
RCW 42.56. WAC 308-408A-030.
HI-625-003 (R/5/17)WA
Click here to START or CLEAR, then hit the TAB button
When you have completed this form, please print it out and sign here.
