Department of Labor and Industries WISHA Services Division Charter Boats PO Box 44650 Olympia WA 98504-4650
CHARTER VESSEL INSPECTION
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Department use only
Last inspection Last dry dock inspection License number Issue date # Passengers allowed # Crew required
Vessel's name Owner's name Owner's address (place to mail certificate) Vessel length (ft) Gross tonnage Hull construction Insurance policy # Beam (ft) City
Body of water certified to perform commercial business Phone number State ZIP+4 Year Fuel Type No. of cylinders per engine Horsepower per engine No. of shafts
Depth (main deck to keel, ft) City and state vessel built (manufacturer) Class of service (passenger, cargo) No. of engines Insurance policy issued by
Date insurance policy expires Date renewal exam due (every 5 yrs)
Licensed operator's name
License number
Date First Aid, CPR expires
Per RCW 88.04.035(1) and RCW 88.04.045(1), the above information is true and correct
Date Owner/Applicant's signature
F416-058-000 chartaer vessel inspection 6-04