Addendum with retail and medical box



Cannabis License Addendum

This form must be submitted with a Business License Application from Business Licensing Services.

Failure to answer all questions and submit payment will result in a delay of your application and your application may not be processed

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|1. |Mark the license type you are requesting (application fees are non-refundable): |

| | Cannabis Transportation | $250 | Cannabis Research |$250 |

| Social Equity Cannabis Retailer $250 |

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|Medical Cannabis |

|(must also select the Social Equity Cannabis Retailer) |

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|2. |Are you taking over a business that has a current WSLCB Cannabis license?.................... | YES NO |

| |If yes, list the current licensee’s Cannabis license number: |      |

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|3. |Primary contact person for questions regarding this application: |      |

| |Phone number: |      |

| |E-mail address: |      |

| |Secondary contact person for questions regarding this application: |      |

| |Phone number: |      |

| |E-mail address: |      |

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|General application questions? Please call Business Licensing Services at 360-705-6741. |

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