Location Addendum to the Master Business Application (Washington)
This form is an application to change a business location. The form provided here is simply a sample of what the actual Form 700-029 looks like.
Master License Service
Department of Licensing
P O Box 9034
Olympia WA 98507-9034
Unified Business Identifier (UBI) Number ________________________
Owner Name ___________________________________
For Validation - Office Use Only
01P-400-731-0003
LOCATION ADDENDUM TO THE MASTER BUSINESS APPLICATION
Complete one Location Addendum for each business location not listed on the Master Business Application. This form must accompany a Master Business Application.
1. LIST REGISTRATIONS, LICENSES, TRADE NAMES AND ANY REQUIRED FEES BELOW
See enclosed "Registration and License Description Sheet" for the information needed to complete this list.
REGISTRATION OR LICENSE TYPE ______________ FEE $_____________
REGISTRATION OR LICENSE TYPE ______________ FEE $_____________
REGISTRATION OR LICENSE TYPE ______________ FEE $_____________
MASTER APPLICATION FEE $15.00
TOTAL AMOUNT DUE $___________
A. BUSINESS INFORMATION (Complete for actual location where business will be conducted.)
Date business first will be (was) conducted, under this owner, at this WA location:
(____) ________ Mo ________ Day _______ Yr
Firm/Trade Name ________________________________
Business Mailing Address
Street or Route ________________________________,
P.O. Box ________________________________,
City ________________________________,
State ________________________________,
Zip ________________________________
Business Telephone Number (________)________________________
Business Location - Physical location only
Street or Route ________________________________,
City ________________________________,
State ________________________________,
Zip ________________________________
FAX Number (________)________________________________
Is this location within city limits? ____ YES ____ NO
If yes, which city? ________________________________
County ________________________________
Describe in detail the principal products or services you provide in Washington: (product manufactured or sold, type of construction, etc.)
________________________________
B. COMPLETE IF THE BUSINESS YOU ARE REGISTERING HAD A PRIOR OWNER
Did you buy, lease or acquire all or part of an existing business? ____ YES ____ NO
If yes, check one box ____ ALL ____ PART
Date Bought/Leased/Acquired ______ Mo ______ Day ______ Yr
Previous Business Name ________________________________
Previous Owner's Telephone No. (________)______________________
Previous Owner's Name ________________________________
Address ________________________________
Still in Business? ____YES ____ NO
C. COMPLETE IF YOU EMPLOY OR PLAN TO EMPLOY ONE OR MORE PERSONS IN WASHINGTON
Date of first employment of planned employment at this location ______________
Number of persons you employ or plan to employ at this location (Do not include owners) __________________
Of these, how many are or will be minors (under age 18)? _________________
Are any of these minors under age 16? ____ YES ____ NO
List the specific duties performed by minors at this location ________________________________
Are the minors working in an agricultural business? ____ YES ____ NO
Describe in detail the activities of your employees ________________________________
D. SIGNATURE OF SOLE PROPRIETOR OR SPOUSE, PARTNER, OR CORPORATE OFFICER
I, the undersigned, declare under the penalties of perjury and/or the revocation of any license granted, that I am the applicant or authorized representative of the firm making this application and that the answers contained, including any accompanying information have been examined by me and that the matters and things set forth are true, correct and complete.
Signature required (If a corporation, a corporate officer must sign)
X________________________________
Title ________________________________
Date ________________________________