Construction Review Services 360-236-2944 http://www.doh.wa.gov/crs Application Checklist and Instructions Please indicate if you have previously submitted an application for the scope of work defined by the project. Examples include: technical assistance projects that have become real projects or projects where the scope has significantly changed. Section #1: Demographic Information: Owner/Operator Information Legal Owner/Operator Name: Enter the as it appears on the owner’s name UBI/ Master Business License. Mailing Address: Enter the legal owner/operator’s complete mailing address. Uniform Business Identifier Number (UBI #): Enter your Washington State UBI #. All Washington State businesses must have UBI and #’s. City, county, state government departments also have UBI #’s. Phone: Enter the phone. owner/operator’s Email and Web Address: Enter the email and Web owner/operator’s address, if applicable. Facility Information Facility Name: Enter the name as advertised on signs or website. facility’s The facility name should match the name given to the Department in previous applications, and should be the same as indicated on the facility license (if currently licensed). Site Address: Enter the physical street location of the location where facility’s the construction or renovation will occur including city, state, zip and county. Be sure to include a suite number, if you have one. Phone: Enter the phone number. facility’s
Construction Review Services 360-236-2944 http://www.doh.wa.gov/crs Application Checklist and Instructions Please indicate if you have previously submitted an application for the scope of work defined by the project. Examples include: technical assistance projects that have become real projects or projects where the scope has significantly changed. Section #1: Demographic Information: Owner/Operator Information Legal Owner/Operator Name: Enter the owner’s name as it appears on the UBI/ Master Business License. Mailing Address: Enter the legal owner/operator’s complete mailing address. Uniform Business Identifier Number (UBI #): Enter your Washington State UBI #. All Washington State businesses must have UBI #’s. City, county, and state government departments also have UBI #’s. Phone: Enter the owner/operator’s phone. Email and Web Address: Enter the owner/operator’s email and Web address, if applicable. Facility Information Facility Name: Enter the facility’s name as advertised on signs or website. The facility name should match the name given to the Department in previous applications, and should be the same as indicated on the facility license (if currently licensed). Site Address: Enter the facility’s physical street location of the location where the construction or renovation will occur including city, state, zip and county. Be sure to include a suite number, if you have one. Phone: Enter the facility’s phone number.
505-047CRS-AppPacket.docx