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Location Addendum To The Master Application Form. This is a Washington form and can be use in Liquor Control Board Statewide.
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Tags: Location Addendum To The Master Application, BLS-700-029, Washington Statewide, Liquor Control Board
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.
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