Form ENLS-651-026 "On-Site Wastewater Treatment System Designer Renewal Application" - Washington

What Is Form ENLS-651-026?

This is a legal form that was released by the Washington State Department of Licensing - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2019;
  • The latest edition provided by the Washington State Department of Licensing;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form ENLS-651-026 by clicking the link below or browse more documents and templates provided by the Washington State Department of Licensing.

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Download Form ENLS-651-026 "On-Site Wastewater Treatment System Designer Renewal Application" - Washington

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On-Site Wastewater
Treatment System Designer
Renewal Application
Renew your On-Site Wastewater Treatment System Designer license.
Online:
https://professions.dol.wa.gov
Or mail this completed form with a check or money order for the renewal fee
(payable to the Department of Licensing) to:
Board of Registration for Professional Engineers and Land Surveyors
Department of Licensing
PO Box 3777
Seattle WA 98124-3777
For questions or language help call: (360) 664-1575
Fees
$116 for 2-year renewal
$174 for late renewal (90 days after license expiration date)
Licenses are available for self-printing with an online account.
If you want us to print and mail your license add a $5 print fee for each copy to your payment.
$0 self-print license online.
$5 each. DOL print and mail license. Quantity
Total $
Applicant information
TYPE or PRINT Name (Last, First, Middle)
License number
Mailing address
City
State
ZIP code
(Area code) Contact phone number
Email
Legal background
Answer the following
Answer the questions below. If you answer “Yes,” attach a detailed explanation.
1. Within the last 5 years, in this state or any other jurisdiction, have you had any action
(fine, suspension, revocation, censure, surrender, etc.) taken against any professional or
occupational license, certification, or permit held by you?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
2. Within the last 5 years, in this state or any other jurisdiction, have you defaulted, or been
convicted of, or entered a plea of no contest to a gross misdemeanor or felony crime?
(Don’t include traffic convictions.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
Professional development
Certification
I have completed a total of 30 professional development hours within the last two years and
I understand these hours are subject to audit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
I declare under penalty of perjury under the law of Washington that the foregoing is true and correct.
TYPE or PRINT Name
X
When you have completed this form, please print it out and sign here.
Date and place
Applicant signature
Providing any false information in this application may be cause for denial, suspension, or revocation of your
professional license in the State of Washington.
ENLS-651-026 (R/6/20)WA
Click here to START or CLEAR, then hit the TAB button
On-Site Wastewater
Treatment System Designer
Renewal Application
Renew your On-Site Wastewater Treatment System Designer license.
Online:
https://professions.dol.wa.gov
Or mail this completed form with a check or money order for the renewal fee
(payable to the Department of Licensing) to:
Board of Registration for Professional Engineers and Land Surveyors
Department of Licensing
PO Box 3777
Seattle WA 98124-3777
For questions or language help call: (360) 664-1575
Fees
$116 for 2-year renewal
$174 for late renewal (90 days after license expiration date)
Licenses are available for self-printing with an online account.
If you want us to print and mail your license add a $5 print fee for each copy to your payment.
$0 self-print license online.
$5 each. DOL print and mail license. Quantity
Total $
Applicant information
TYPE or PRINT Name (Last, First, Middle)
License number
Mailing address
City
State
ZIP code
(Area code) Contact phone number
Email
Legal background
Answer the following
Answer the questions below. If you answer “Yes,” attach a detailed explanation.
1. Within the last 5 years, in this state or any other jurisdiction, have you had any action
(fine, suspension, revocation, censure, surrender, etc.) taken against any professional or
occupational license, certification, or permit held by you?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
2. Within the last 5 years, in this state or any other jurisdiction, have you defaulted, or been
convicted of, or entered a plea of no contest to a gross misdemeanor or felony crime?
(Don’t include traffic convictions.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
Professional development
Certification
I have completed a total of 30 professional development hours within the last two years and
I understand these hours are subject to audit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
I declare under penalty of perjury under the law of Washington that the foregoing is true and correct.
TYPE or PRINT Name
X
When you have completed this form, please print it out and sign here.
Date and place
Applicant signature
Providing any false information in this application may be cause for denial, suspension, or revocation of your
professional license in the State of Washington.
ENLS-651-026 (R/6/20)WA