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Fillable Printable Licensed Home Inspector Renewal Application

Fillable Printable Licensed Home Inspector Renewal Application

Licensed Home Inspector Renewal Application

Licensed Home Inspector Renewal Application

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Licensed Home Inspector
Renewal Application
You can use this form to apply for a renewal of your Home Inspector License.
To renew and prevent interruption of your license, read, complete, and sign
this application and send it with a check or money order for payable to the
Department of Licensing to:
Home Inspector Licensing
Department of Licensing
PO Box 3917
Seattle WA 98124-3917
License renewal fee - $375
Late renewal - $435
TYPE or PRINT Name (as it appears on your license)
Mailing address
City State ZIP code
License number Social Security number required*
(Area code) Daytime telephone (Area code) Fax number Email address
Continuing education
Have you taken 24 clock hours of approved continuing home inspector education as required
by RCW 18.280.100 and WAC 308-408A-110 and can you provide documentation to the
Department of Licensing if requested? .................................................... Yes No
Legal
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.
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
Date and place Signature
Providing false information on this application shall constitute cause for denial, suspension, or revocation of this license.
HI-625-004 (R/5/17)WA
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When you have completed this form, please print it out and sign here.
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