Fee Waiver/Reduction Request
-509905-738505 Construction Review Services Program (CRS)Fee Waiver/ Fee Reduction Request FormWAC 246-314-990 (1) and (5)(b), (5)(c)Health care facilities must use this form to request a fee waiver or fee reduction. Sign and submit it to CRS prior to submitting an application for plan review.Facility Name: FORMTEXT ????? Street/PO Box: FORMTEXT ?????City: FORMTEXT ?????State: FORMTEXT ?????Zip Code: FORMTEXT ?????Project Title: FORMTEXT ?????Fee Waiver Request (complete only if Fee Waiver per WAC 246-314-990(1) applies). Please attach supporting documents, such as: purchase order, cost estimate(s) from manufacturer, etc.Type of Fixed/Installed Technologically Advanced Clinical Equipment: FORMTEXT ?????Manufacturer: FORMTEXT ?????Model: FORMTEXT ?????Cost: FORMTEXT ?????Fee Reduction Request (complete only if an Architect is Not Required per WAC 246-314-990(5)(b) or if Occupancy/License Conversion per WAC 246-314-990(5)(c) applies)Description of why this reduction applies: FORMTEXT ?????Facility Representative (Required): X FORMTEXT ?????X Signed By (please print)SignaturePlease return the completed and signed form along with the supporting documents to:Mail: Construction Review ServicesAttn: Permit Technician111 Israel Rd SE, MS: 47852Tumwater, WA. 98501Email:fslcrs@doh. ................
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