Vehicle Transport/Disposal Addendum

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BLS-700-183 (R/04/08) Page 1 of 2 Vehicle Transport/Disposal Addendum (To apply for a license as a Registered Tow Truck Operator, Vehicle Transporter, Hulk Hauler, Wrecker and/or Scrap Processor) This addendum form may only be submitted as an attachment to the Master Business Application form. The Department of Licensing has a policy of providing equal access to its services. If you need special accommodation, call (360) 664-1400 or TTY (360) 664-8885. Master License Service
Department of Licensing
PO Box 9034
Olympia, WA 98507-9034
(360) 664-1400 UBI Owner name A Licenses requested All applicants Reg. Tow Truck Operator (244) Hulk Hauler (247) Scrap Processor (254) Vehicle Transporter (242) Motor Vehicle Wrecker (250) Note: Corporations or Limited Liability Company ownership types must attach the Corporate Information or LLC Information sheet
listing all individuals with 10% or more interest in your business. B Registered Tow Truck Operator additional information 1. Have you ever been assigned a Registered Tow Truck Operator registration number? ..................................... Yes No If Yes, give the previous business name: and number: 2. Have you ever had that registration suspended or revoked? ................................................................................. If Yes, attach an explanation of the suspension or revocation. Yes No 3. If you maintain additional secured vehicle storage/impound areas away from this location, please see the instruction sheet. 4. You must attach all of the following lists and completed documents to this application (see instruction sheet for descriptions): Names & addresses of all employees who serve as tow truck drivers Proof of Registered Tow Truck Operator liability insurance Registered Tow Truck Operator bond Fee schedule Washington State Patrol Tow Truck-Business-Operator-Equipment Inspection Report C Vehicle Transporter additional information The transporter plates/license cannot be used to transport vehicles owned or registered to the licensee or business, unless
you are a registered tow truck operator. (RCW 46.76.065) Is your transport business available to the general public? ...................................................................................... Yes No As a licensed transporter, will you provide towing services for pay? ......................................................................... Yes No If you answered "yes" to the previous question, will you also hold a Registered Tow Truck (RTTO) license? ........... Yes No Indicate the number of Vehicle Transporter license plates you require: Of ce use only This section will be completed by Washington Utilities and Transportation Commission This will certify that Name of business (Check one) has been issued a common carrier permit, number _______________________ , pursuant to chapter 81.80 RCW. is exempt under chapter 81.80 RCW and therefore not required to obtain a common carrier permit. requires a WUTC permit but has not been issued a WUTC permit.
WUTC is unable to determine if a WUTC permit is required based on information submitted. Signature of WA Utilities & Transportation Comm. representative X Title of representative Date signed Form continued on reverse . . . BLS-700-183 (R/04/08) Page 2 of 2 D Hulk Hauler, Wrecker, and Scrap Processor additional information Hulk Hauler, Wrecker, and Scrap Processor applicants
If applying for any of these three licenses, you must attach a list of the vehicles owned, leased, rented, or otherwise operated in the
conduct of your business. A blank Vehicles Used to Conduct Business form is enclosed. Scrap Processor and Wrecker applicants only
You must also complete a State Environmental Policy Act (SEPA) checklist, present it to the local zoning of cial for review (see
section F), and then attach the completed checklist to this application. A blank checklist is enclosed. Wrecker applicants only, attach the following completed forms (blank forms provided) Personal/Criminal History Form Bond of Motor Vehicle Wrecker If you have additional (branch) Motor Vehicle Wrecker business locations in the same county as this business location, please see the
instructions sheet for information about registering the other locations. E Business site identi cation Certi cations in sections C, F and G apply to the following business location Business rm name Business telephone number ( ) Business physical location address Street or Rural route Do not use PO box number City County State Zip code F Zoning certi cation Reg. Tow Truck Operator, Wrecker, Hulk Hauler, and/or Scrap Processor applicants only This section must be completed and signed by the local zoning authority before submitting the application to the Master License
Service. Zoning Of cer: Check either "yes" or "no" for each option, then sign. 1. Applicant is applying as a Registered Tow Truck Operator ................................................................................. Yes No 2. Applicant is applying as a Hulk Hauler ................................................................................................................. Yes No If "yes" is checked for #1 or #2 above, my signature below certi es that this Registered Tow Truck Operator or Hulk Hauler
applicant's place of business is in compliance with all applicable local land use ordinances. 3. Applicant is applying as a Motor Vehicle Wrecker ............................................................................................... Yes No 4. Applicant is applying as a Scrap Processor ........................................................................................................ Yes No If "yes" is checked for #3 or #4 above, my signature below certi es that the environmental impact from this proposed land use
for a Motor Vehicle Wrecker or Scrap Processor business appears insigni cant, pursuant to Chapter 43.21 RCW, the state
Environmental Policy, WAC 197-11-305, WAC 197-11-820, and WAC 197-11-800(14)(i). A completed State Environmental Policy
Act (SEPA) checklist must be attached. Signature of local zoning of cial X Title of local zoning of cial Date signed G Inspecting Of cer approval Hulk Hauler, Wrecker, and/or Scrap Processor applicants only Before submitting your Master Application, you must contact the Washington State Patrol or the local Chief of Police (if business is
located in a city with a population of more than 5,000). You need to arrange for them to do a site inspection, review your entire
application, and sign this form. Inspecting Of cer: Check either "yes" or "no" for each option, then sign. 1. Applicant is applying as a Hulk Hauler ................................................................................................................. Yes No 2. Applicant is applying as a Scrap Processor ........................................................................................................ Yes No If "yes" is checked for #1 or #2 above, my signature below certi es that this Hulk Hauler or Scrap Processor applicant is located
at the address shown in section E above and has suitable equipment for the safe and lawful transport of vehicle salvage on the
public highways. The applicant has displayed with letters and numerals at least three inches high, painted or permanently af xed
to each vehicle, the business name, complete address of place of business, and current business telephone number on all
vehicles operated by the applicant on highways of this state and which are equipped for lifting or transporting vehicles or hulks. 3. Applicant is applying as a Motor Vehicle Wrecker ............................................................................................... Yes No If "yes" is checked for #3 above, my signature below certi es that this Motor Vehicle Wrecker applicant is located at the address
shown in section E above, as de ned by RCW 46.80.010, and has displayed with letters or numerals at least three inches
high, painted or permanently af xed to each vehicle, the business name, city name of place of business, and current business
telephone number on all vehicles operated by the applicant on highways of this state and which are equipped for lifting or
transporting vehicles or hulks. I assume responsibility for enforcement of the certi cations stated above. Signature of inspecting of cer X Title of inspecting of cer Badge number Date signed

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