MASTER LICENSE SERVICE DEPARTMENT OF LICENSING PO BOX 9034 OLYMPIA, WA 98507-9034 UBI NUMBER OWNER NAME (Please print clearly) Information provided may be subject to disclosure under the public disclosure law (RCW 42. 56) FOR VALIDATION — OFFICE USE ONLY LOCATION ADDENDUM TO THE MASTER APPLICATION Complete one Location Addendum for each business location not listed on the Master Application. This form must accompany a Master Application. 01P-400-925-0003 1. LIST REGISTRATIONS, LICENSES, TRADE NAMES AND ANY REQUIRED FEES BELOW Use the"License Fee Sheet" for the information needed to complete this list. REGISTRATION OR LICENSE TYPE FEE $ $ $ $ Enclose a check for the total amount due, including the Application Fee, which MUST be submitted with this form APPLICATION FEE $ !Make check payable to the WASHINGTON STATE TREASURER. TOTAL AMOUNT DUE $ A BUSINESS INFORMATION Date business first will be (was) conducted, under this owner, at this WA location: (Complete for actual location where business will be conducted.) Firm/Trade Name Business Mailing Address (Street or Route, P.O. Box, City, State, Zip) Mo Day 15.00 Business Telephone Number ( Yr Business Location (Street or Route, City, State, Zip — Physical location only) Is this location within city limits? If yes, which city? YES ) FAX Number County NO 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? If yes, check one box ALL Previous Business Name Date Bought/Leased/Acquired YES C NO Mo Previous Owner's Telephone No. ( PART Day Still in Business? ) YES NO Previous Owner's Name and Address Yr COMPLETE IF YOU EMPLOY OR PLAN TO EMPLOY ONE OR MORE PERSONS IN WASHINGTON Date of first employment of planned employment at this location List the specific duties performed by minors 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? Are the minors working in an agricultural business? YES NO 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. Signaturerequired Title Date X BLS-700-029 LOC ADD TO MASTER BUSINESS APP (R/10/06)OR The Department of Licensing has a policy of providing equal access to its services. If you need special accommodation, please call (360) 664-1400 or TTY (360) 664-8885. American LegalNet, Inc. www.FormsWorkflow.com