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2004, 05-28 Hulk Hauler App Page 2 only4 HULK HAULER, WRECKER AND SCRAP PROCESSOR ADDITIONAL INFORMATION Hulk Hauler, Wrecker & 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 Listing of Vehicles Used to Conduct Business form is enclosed. Scrap Processor & Wrecker Applicants Only You must also complete a State Environmental Policy Act (SEPA) checklist, present it to the local zoning official for review (see section 6), 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): • PersoriaVCriminal 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 those other locations. © BUSINESS SITE IDENTIFICATION (Certifications in sections 6 and 7 below apply to this following business location) Business Firm Name* Physical Location Address of Business* t 5 04-4 t r �c�D�t e 3(5{9-17 N.0 -- ( SDI ) 974- -763s Business Phone Number Street or Rural Route Address of Place of Business (do NOT use a PO Box) 1) City County ttiA 420g- State Zip Code ii ZONING CERTIFICATION (Registered Tow Truck Operator, Wrecker, Hulk Hauler and/or Scrap Processor applicants only) This section to be completed by the local zoning authority. Check either 'yes' or 'no' for each option and sign. Applicant is applying as a Registered Tow Truck Operator Yes 0 No Applicant is applying as a HulkHauler 10 Yes g No If 'yes' is checked, my signature below certifies that this Registered Tow Truck Operator or Hulk Hauler applicant's place of business is in compliance with all applicable local land use ordinances. Applicant is applying as a Motor Vehicle Wrecker 0 Yes g No Applicant is applying as a Scrap Processor 0 Yes No If 'yes' is checked, my signature below certifies that the environmental impact from this proposed land use for a Motor Vehicle Wrecker or Scrap Processor business appears insignificant, 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). completed State Environmental Policy Act (SEPA) checklist must be attached. Oolliietelgh? CaNAbffiltiA 05% 2Y• oq Title of Local Zoning Officia Date of Signature Si re of L I '. ing Official INSPECTING OFFICER APPROVAL (for Hulk Hauler, Scrap Processor, and/or Wrecker applicants only) This section to be completed by the Washington State Patrol, or by the Local Chief of Police (if business is located in a city with more than 5,000 population). Check either 'yes' or 'no' for each option and sign. Applicant is applying as a Hulk Hauler 0 Yes 0 No Applicant is applying as a Scrap Processor 0 Yes 0 No If 'yes' is checked, my signature below certifies that this Hulk Hauler or Scrap Processor applicant is located at the address shown in section 5 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 affixed 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. Applicant is applying as a Motor Vehicle Wrecker 0 Yes 0 No If 'yes' is checked, my signature below certifies that this Motor Vehicle Wrecker applicant is located at the address shown in section 5 above, as defined by RCW 46.80.010, and has displayed with letters or numerals at least three inches high, painted or permanently affixed 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. Signature of Inspecting Officer Title of Inspecting Officer Date of Signature BLS•700-183 VEHICLETRNSPTIDISPADD (R/12/02)OR Page 2 of2