PERSONAL INFORMATION PROVIDED TO THE WASHINGTON DEPARTMENT OF FISH AND WILDLIFE MAY BE DISCLOSED VIA A PUBLIC RECORDS REQUEST. All the information you provide in this application form becomes a public record that may be subject to inspection and copying by members of the public, unless an exemption in law exists. The Department’s policy regarding Privacy Protection and Public Disclosure Requests is available upon request.

Falconry Facility Inspection Report

DATE Initial Inspection Re-inspection Move to WA Other Applicant Information

Apprentice Applicant Apprentice Permit Holder General Permit Holder Master Permit Holder

Falconry Permit # if applicable

Name: Male Female

Home Phone: Work Phone: Cell Phone:

Email address:

FACILITY ADDRESS: City: Zip Code:

HOME ADDRESS: City: Zip Code:

Equipment – Minimum Standard Equipment as Required By Regulations

Item Yes No Comments Anklets – may be on or off bird Jesses – may be on or off bird Leash – may be on or off bird Swivel – may be on or off bird Water for drinking and bathing Bath pan Food stored properly in adequate quantity Perch appropriate for species Weighing instrument appropriate for species

Facilities

The primary consideration for raptor housing whether indoors or outdoors is protection from predators, environment, domestic animals, or excessive disturbance. Please refer to WAC 232-30-410 through WAC 232-30-460 for acceptable facility requirements.

Facilities Yes No Comments Primary housing is in-home (no outdoor mews) Primary housing is outdoor separate structure Protection from all elements (wind, sun, precipitation, heat, cold) Protection from predators and domestic animals Protection from excessive disturbance Adequate ventilation control Safe window coverings (vertical lathing, slats, dowels, appropriate netting) Substrate easy for cleaning 1 | Page

Approximate size of loft or enclosure  Please Comments 6 X 6 X 6 Small falcons; small accipiter 6 X 8 X 7 Medium falcons and similar size 8 X 8 X 7 Large buteos and similar size 10 X 10 X 10 Golden eagle (special permit only); gyrfalcon

Unacceptable facilities include: • Pet store bird cages • Any chicken wire or hardware cloth anywhere in enclosure • Exposed sharp obstructions or objects • Exposure to the elements • Unsanitary conditions such as unclean chicken coops or pigeon lofts • Unsanitary conditions such as accumulated feces, decaying food, muddy or wet ground substrate • Discoloration of walls to indicate bacterial build up.

Raptors in Possession

Raptor Species in Possession: Band # if applicable Is Form 3-186A available?

Raptor Health Yes No Comments Is there evidence of feather damage from the housing? Is there evidence of beak &/or cere damage due to housing? Do raptors appear to be in poor health?

Signatures

APPROVED RE-INSPECTION NEEDED FOR APPROVAL

Print Inspector’s Name

Inspector’s Signature Date

Affiliation: WDFW WFA Other WA licensed falconer

Sponsor Information

Name: Permit Class:

Mailing Address: City: Zip Code:

APPLICANT’S CERTIFICATION AND SIGNATURE I certify that I have read and am familiar with the Washington Department of Fish and Wildlife’s falconry and hunting regulations and the U.S. Fish and Wildlife Service falconry regulations, and the federal Migratory Bird Treaty Act, and that the information I have submitted is complete and accurate to the best of my knowledge and belief. I understand that any false statement herein may subject me to cancellation of the application, revocation of my falconry permit, and/or criminal penalties.

Applicant’s Signature Date

If the Applicant is less than 18 years of age a Parent or Guardian must sign this application:

Parent or Guardian’s signature Date

Please return completed form to: Falconry Manager, WDFW, 16018 Mill Creek Blvd, Mill Creek WA 98012 Revised 11/2014 2 | Page