Washington State Lien Waiver Form

{{company_name}}

{{company_address}}

Phone: {{phone}} | Email: {{email}} | Web: {{website}}

Washington State Lien Waiver Form

Washington State Lien Waiver Form

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

CONDITIONAL WAIVER AND RELEASE OF LIEN UPON PROGRESS PAYMENT

Upon receipt by the undersigned of a check in the sum of {{payment_amount}} U.S. Dollars ($), payable to the undersigned, and when the check has been properly endorsed and has been paid by the bank upon which it is drawn, this document shall become effective to release any mechanic’s lien, stop notice, or bond right the undersigned has on the job of {{owner_name}}, located at {{project_address}} to the following extent.

Extent of Waiver

This release covers a progress payment for the work, materials, or equipment furnished by the undersigned to the {{customer_name}} through {{date_of_payment_period}}. This release does not cover any retention or items furnished after said date. Before any recipient of this document relies on it, the party should verify evidence of payment to the undersigned.

Notice

This document waives and releases lien, stop notice, and bond rights only to the extent set forth above, even if you have signed a document purporting to waive and release these rights in full.

Declaration of Payment Status

The undersigned declares that it has received {{previously_received_amount}} as partial payment for the work, materials, or equipment furnished to the above-referenced project. The remaining balance due for work, materials, or equipment through the date of this waiver is {{remaining_balance_due}}.

Identification of Parties and Project

Claimant: {{claimant_name}}

Claimant's Customer: {{customer_name}}

Property Owner: {{owner_name}}

Project Name/Description: {{project_description}}

Project Location: {{project_address}}

Signature

Dated: {{date}}

_________________________________________

{{signer_name}}

{{signer_title}}

Company Name: {{company_name}}