State of Washington Business Licensing Service PO Box 9034 Olympia WA 98507-9034 Telephone: 1-800-451-7985 business.wa.gov/BLS For Validation - Office Use Only Business License Application For faster service apply online at business.wa.gov/BLS Online applications are typically processed within ten business days. It may take up to six weeks if you file by mail. Legal Entity/Owner Name Unified Business Identifier (UBI) Federal Employer Identification Number (FEIN) 1. Purpose of Application Please check all boxes that apply. Open/Reopen Business complete sections 2, 3, 4, (5 if hiring employees) and 6 Add Endorsement/Registration to Existing Location complete sections 2, 3, 4, and 6 Open Additional Location complete sections 2, 3, 4, (5 if hiring employees) and 6 Business Has or Will Have Employees complete all sections Change Ownership complete sections 2, 3, 4, (5 if you have employees) and 6 Business Has or Will Have Employees Under Age 18 complete all sections (If this business location has an active Workers' Compensation account with L&I, and there were no business changes since the last Business License Application was filed, complete only sections 2, 3a, 3c, 3d, [and 3f for sole proprietors], 5c, and 6.) Register Trade Name complete sections 2, 3, 4 and 6 Change Trade Name - complete sections 2, 3, 4 and 6 Name(s) to be cancelled: ________________________ _____________________________________________ Hire Persons to Work In or Around Your Home complete all sections Change Location - complete sections 2, 3, 4 and 6 Other - complete all Old address to be closed:______________________________________________________________________________________ 2. Endorsements and Fees Use the Endorsement Fee Sheet for the information needed to complete this list. Mark Registrations Needed: Tax Registration (State Dept. of Revenue) ­ Do you want a separate tax return for each business? Industrial Insurance (Workers' Compensation) ­ Required if you will have employees. Unemployment Insurance ­ Required if you will have employees. Minor Work Permit ­ Required if you will have employees under age 18. New Trade Name (Doing Business As): List Additional Trade Names ($5 each name) or Other Endorsements (such as Lottery Retailer): Yes No Fees Due No Fee No Fee No Fee No Fee $ 5.00 $ $ $ $ $ Enclose check for total amount due, including the non-refundable Processing Fee, which MUST be submitted with this form. Processing Fee Total Amount Due $ 19.00 $ Make check payable to the Department of Revenue. To receive this document in an alternate format, please call 1-800-647-7706. Teletype (TTY) users may use the Washington Relay Service by calling 711. BLS-700-028 (3/3/17) PAGE 1 OF 4 American LegalNet, Inc. www.FormsWorkFlow.com 3. Owner Information a.*Select only ONE ownership structure: Sole Proprietorship If married, should spouse's name appear on license? Ownership Structures Yes No (If you answer No, you must still enter the spouse information in section "3f" below.) Corporation* Non Profit Corporation* (educational, religious, charitable) Limited Liability Company* Partnership (# of partners:_____) Joint Venture Limited Partnership* Limited Liability Partnership* Limited Liability Limited Partnership* *These ownership structures must contact the Secretary of State office for additional filing requirements. Name of Corporation, LLC, Partnership, LLP, LLLP, or Joint Venture Name (examples: ABC, Inc. OR Fir Trees Unlimited LLC) State incorporated/formed: ____________________________ Year incorporated/formed: ____________________________ Association Trust Municipality Tribal Government Other Name of Organization (example: Anderson Family Trust) b.*Business Open Date MM DD c. *Business Name/Trade Name d. *Business Mailing Address (Street or PO Box, Suite No. do not use builiding name) City State Zip code City e. ( f. ) Business Telephone Number List all owners & spouses: Sole proprietor, partners, officers, or LLC members. (Attach additional pages if needed.) ___________________________________________________________ (Last, First, Middle) *Name ___________________________________________________________ Home Address (Street or PO Box) ________________________ Title _________________________________ Home Telephone Number* ( ___________________________________________________________ Spouse Name (Last, First, Middle) Governing Persons ___________________________________________________________ Name (Last, First, Middle) ___________________________________________________________ Home Address (Street or PO Box) ________________________ Title _________________________________ Home Telephone Number* ( ___________________________________________________________ Spouse Name (Last, First, Middle) ___________________________________________________________ Name (Last, First, Middle) ___________________________________________________________ Home Address (Street or PO Box) ________________________ Title _________________________________ Home Telephone Number* ( ___________________________________________________________ Spouse Name (Last, First, Middle) *The Social Security Number is required for sole proprietors, partners, officers, and LLC members of businesses that will have employees. (WAC 192-310-010) Not fully completing section "f" will result in application delays. BLS-700-028 (3/3/17) PAGE 2 OF 4 American LegalNet, Inc. www.FormsWorkFlow.com / YY / Provide the ownership structure's first date of business at this location. Out-of-state businesses should use the first date of operation in WA. (Required. If unknown, please estimate.) Is this location inside city limits? Yes No *Business Street Address (if different than mailing) Do not use PO Box or PMB State Zip code ( ) E-Mail Address Fax Number ___________________________ Social Security Number* _________________ Date of Birth / / _____________ % Owned* ____________________________________________________________ City State Zip code ) Are you married? Yes No If yes, enter spouse information below. ____________________ Spouse Date of Birth __________________________________ Spouse Social Security Number ___________________________ Social Security Number* / / _________________ Date of Birth / / ____________ % Owned* ____________________________________________________________ City State Zip code ) Are you married? Yes No If yes, enter spouse information below. _____________________ Spouse Date of Birth ____________________________________ Spouse Socia