Fillable Printable Real Estate Appraiser Temporary Practice Applicatio
Fillable Printable Real Estate Appraiser Temporary Practice Applicatio
Real Estate Appraiser Temporary Practice Applicatio
Real Estate Appraiser
Temporary Practice Application
You can use this form to apply for a temporary permit to practice as a real
estate appraiser. Temporary permits are valid for six months from the date of
issuance but may be extended. Application must be notarized.
Your application must include
a copy of the Assignment Contract:
• on letterhead
• dated and signed
• with the subject addresses
• describe the scope of the assignment
• show the due date
Send this completed form and all required attachments with a check or money order for the $150 non-refundable fee
payable to Department of Licensing, to:
Real Estate Appraiser
Department of Licensing
PO Box 3917
Seattle, WA 98124-3917
Temporary permit type (choose only one):
Certified general
Certified residential
State licensed
Applicant
TYPE or PRINT Name (Last, First, Middle)
Social Security number required*
Date of birth
Mailing address
City State ZIP code
Business name
Business physical address (current physical location of business is required)
City State ZIP code
(Area code) Telephone (during normal business hours) Email Gender
M F
Answer the following
Have you ever applied for licensure/certification as a real estate appraiser in Washington State? . . . . Yes No
Are you currently licensed in Washington State as a real estate salesperson, broker or associate
broker, or escrow agent? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
If “Yes,” what is your license number?
What is the full name under which you are licensed?
(As it appears on your license)
*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.
Out-of-state information
State Month/Year issued Number Status
Active Inactive
Month/Year expired
Full name under which you are licensed (as it appears on your license)
APR-622-181 (R/7/15)WA Page 1 of 2
Click here to START or CLEAR, then hit the TAB button
Notary – All signatures must be notarized
State of _________________ , County of ___________________________________
Signed or attested before me on ________ by _______________________________
(Seal or stamp) _________________________________
Signature
_________________________________
Printed or stamped name
__________________________________ and ______________________________
Title Expiration date of appointment
Attestation – Your signature must be notarized
I, the undersigned, certify that I am the person referred to in this application for a temporary permit as a real estate
appraiser in the state of Washington, that I have read and understand RCW 18.140 and WAC 308-125. I have carefully
read the questions in this application and have answered them completely, without reservations of any kind, and I
declare under penalty of perjury that my answers and all statements made by me are true and correct. Should I furnish
any false information in this application, I agree that it will be cause for the denial, suspension, or revocation of my
temporary permit to practice as a certified/licensed real estate appraiser in Washington State.
I authorize all organizations, my references, employers (past and present), business and professional associates (past
and present), and all governmental agencies (local, state, federal or foreign) to release to the Department of Licensing
any information, files, or records requested by the Department to process this application.
Applicant signature Date
Consent to service – Requirement for all out-of-state applicants (signature must be notarized)
I, the undersigned, residing in the state of , have obtained or am about
to obtain a registration/license/certification from the state of Washington to engage or continue in the business of real
estate appraising. I irrevocably consent that suits and actions may be commenced against me in any county of the state
of Washington in which any party/plaintiff having cause of action against me may reside and that service of any process
or pleading in an action or suit may be made by delivering it to the Director of the Department of Licensing of the state
of Washington, at Olympia, Washington.
TYPE or PRINT Name
Applicant signature Date
APR-622-181 (R/7/15)WA Page 2 of 2
X
X
When you have completed this form, please print it out and sign and date here.
When completed, sign and date here.
