HomeMy WebLinkAbout*Other - BOCCGRANT COUNTY
COMMISSIONERS AGENDA MEETING REQUEST FORM
(Must be submitted to the Clerk of the Board by 12:00pm on Thursday)
REQUESTING DEPARTMENT: BOCC
REQUEST SUBMITTED BY: CEMANELL
CONTACT PERSON ATTENDING ROUNDTABLE: CEMANELL
CONFIDENTIAL INFORMATION: ❑YES ® NO
DATE: 4/9/2026
PHONE:2931
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Washington State Department of Revenue For Hire Addendum for the Quincy Valley
Shuttle &Tours, LLC stating that Grant County does not license or regulate the For
Hire business type per RCW 81.72.
If necessary, was this document reviewed by accounting? ❑ YES ❑ NO R N/A
If necessary, was this document reviewed by legal? Fm� YES ❑ NO ❑ N/A
oe
DATE OF ACTION: - ^ Z
APPROVE: DENIED ABSTAIN
D1: A,
D2: ;7
D3:
DEFERRED OR CONTINUED TO:
WITHDRAWN :
4/23/24
Department of
Revenue(CA
Washington State
Business Licensing Service
PO Box 9034
Olympia WA 98507-9034
360-705-6741
BLS@dor.wa.gov
Fax: 360-705-6699
UBI number: 606115810
For Hire Addendum
For faster service - Apply online
Questions? Call 360-664-6466 or emailforhire@dol.wa.gov
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For Hire Operator: This form indicates if your For Hire business will be locally regulated.
1. Complete Section A and read Section B.
2. Take this form to your local jurisdiction official and have them complete and sign Section C.Your local
jurisdiction is the city or county (if outside city limits) in which your business is physically located. You
can find contact information for your local jurisdiction at
mrsc.org/Home/Research Tools/Washington-City-and Town-Profiles.aspx (cities) or
mrsc.org/Home/Research-Tools/Washington-County-Profiles.a (counties).
3. Submit this signed and completed form with your business license application or a For Hire change of
location form at: http://www.dol.wa.gov/forms/750206.pdf.
Applicant information
Business owner name: Quincy Valley Shuttle & Tours, LLC
Firm/trade name: Quincy Valley Shuttle &Tours, QVSTWA, QVST, Quincy Valley Shuttle
Type of For Hire business (check one): ❑Taxi ❑ Cabulance 0 Other (For Hire)
For Hire Operator Permit Fee
If the local jurisdiction official answers "No" to the first question in Section C, you must submit a For Hire Per-
mit fee ($110), along with other required fees, with your business license application or your For Hire address
change form.
Continued...
To request this document in an alternate format, please complete the form dor.wa.gov/AccessibilityRequest
or call 360-705-6705. Teletype (TTY) users please dial 711.
BLS 700 200 (5/14/24) Page 1
For Hire Addendum Department ofue �-
(7
Washington State
Local jurisdiction authority
Local jurisdiction official:
Does your jurisdiction, either alone or by agreement with another jurisdiction (e.g., King County), license or
regulate the For Hire business type checked in Section A in accordance with RCW 81.72? 0 Yes No
If yes, is this applicant authorized to operate in your jurisdiction? 0 Yes ❑ No
Local Jurisdiction Official comments (optional):
Signature of local jurisidiction official:
Print name: Kevin R. Burgess
Date: 04/14/2026 Title of local jurisdiction official: Chair of the Board of Commissioners
Phone: 509-754-2011 Jurisdiction name (county/city): Grant County, WA
BLS 700 200 (5/14/24) Page 2