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Today's Date:___Department of Health Services Licensing and Certification State Office: ___ Attention (ESD Supervisor):___Fax Number: ___ Facility CCN: ___ Facility Name___ Name of individual making
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wwwdohwagovlicensespermitsandcertificateslicenses permits and certificates refer to the licenses, permits, and certificates required by the Washington State Department of Health.
Certain businesses, organizations, and individuals are required to file wwwdohwagovlicensespermitsandcertificateslicenses permits and certificates as mandated by the Washington State Department of Health.
To fill out wwwdohwagovlicensespermitsandcertificateslicenses permits and certificates, you need to provide accurate and up-to-date information about your business, organization, or individual status as required by the Washington State Department of Health.
The purpose of wwwdohwagovlicensespermitsandcertificateslicenses permits and certificates is to ensure compliance with health and safety regulations set forth by the Washington State Department of Health.
Information such as business or individual identification, contact information, license/permit/certificate details, and any other specific requirements outlined by the Washington State Department of Health must be reported on wwwdohwagovlicensespermitsandcertificateslicenses permits and certificates.
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