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BLS-700-028 (9/4/19) PAGE 1 OF 4
Open/Reopen Business
Open Additional Location
Add Endorsement/Registration to Existing Location
Change Ownership
Register Trade Name
Change Trade Name
Name(s) to be cancelled: ________________________________________________________________________________________
Change Location
List Additional Trade Names ($5 each name) or Other Endorsements (such as additional state or city endorsements):
Tax Registration (State Dept. of Revenue) – Do you want a separate tax return for each business? Yes No No Fee
Industrial Insurance (Workers’ Compensation) – Required if you will have employees. No Fee
Unemployment Insurance – Required if you will have employees. No Fee
Minor Work Permit – Required if you will have employees under age 18. No Fee
New Trade Name (Doing Business As): $ 5.00
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 three weeks if you le by paper.
State of Washington
Business Licensing Service
PO Box 9034
Olympia WA 98507-9034
Telephone: 360-705-6741
business.wa.gov/BLS
Please check all boxes that apply.
Use the Endorsement Fee Sheet and City Fee Sheet for the information needed to complete this list.
Enclose check for total amount due, including the
non-refundable Processing Fee, which MUST be submitted with this form.
Processing Fee $ 19.00
Total Amount Due $
Mark Registrations Needed: Fees Due
Legal Entity/Owner Name
Unied Business Identier (UBI)
Federal Employer Identication Number (FEIN)
1. Purpose of Application
2. Endorsements and Fees
Make check payable to the Department of Revenue.
For Validation - Ofce Use Only
To receive this document in an alternate format, please call 360-705-6741. Teletype (TTY) users may use the Washington Relay Service by calling 711.
Business Has or Will Have Employees
Business Has or Will Have Employees Under Age 18
If ONLY requesting to add a Minor Work Permit to your account, and
this business location has an active Worker’ Compensation account
with L&I, and there were no business changes since the last Business
License Application was led, complete only sections 2, 3a, 3c, 3d
(and 3f for sole proprietors), 5c and 6.
Hire Persons to Work In or Around Your Home
$
$
$
$
$
Old address to be closed:_________________________________________________________________________________________
Other
RESET
BLS-700-028 (9/4/19) PAGE 2 OF 4
e.
Business Telephone Number Fax Number E-Mail Address
Corporation* Non Prot 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 ofce for additional ling 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: ____________________________
3. Owner Information
*The Social Security Number, home phone number and percentage owned are required for sole proprietors, partners, ofcers, and LLC members of
businesses that will have employees.
(WAC 192-310-010) Not fully completing section “f” will result in application delays.
f. List all owners & spouses: Sole proprietor, partners, ofcers, or LLC members. (Attach additional pages if needed.)
c. Is this location inside city limits? Yes No
*Primary Business Name/Trade Name
( ) ( )
__________________________________________________________________ ___________________________ _________________ _______________
*Name (Last, First, Middle) Social Security Number* Date of Birth % Owned*
__________________________________________________________________ ___________________________________________________________________
Home Address (Street or PO Box) City State Zip code
___________________________ _____________________________________ Are you married? Yes No If yes, enter spouse information below.
Title Home Telephone Number*
__________________________________________________________________ __________________________________ ____________________
Spouse Name (Last, First, Middle)
Spouse Social Security Number Spouse Date of Birth
__________________________________________________________________ ___________________________ _________________ ______________
Name (Last, First, Middle) Social Security Number* Date of Birth % Owned*
__________________________________________________________________ ___________________________________________________________________
Home Address (Street or PO Box) City State Zip code
___________________________ _____________________________________
Are you married? Yes No If yes, enter spouse information below.
Title Home Telephone Number*
__________________________________________________________________ ____________________________________ _____________________
Spouse Name (Last, First, Middle) Spouse Social Security Number Spouse Date of Birth
__________________________________________________________________ ___________________________ __________________ _____________
Name (Last, First, Middle) Social Security Number* Date of Birth % Owned*
__________________________________________________________________ ___________________________________________________________________
Home Address (Street or PO Box) City State Zip code
___________________________ _____________________________________
Are you married? Yes No If yes, enter spouse information below.
Title Home Telephone Number*
__________________________________________________________________ ____________________________________ ______________________
Spouse Name (Last, First, Middle) Spouse Social Security Number Spouse Date of Birth
/ /
/ /
/ /
/ /
/ /
/ /
( )
( )
( )
Association Trust Municipality  Tribal Government
Name of Organization (example: Anderson Family Trust)
a.*Select only ONE ownership structure:
Sole Proprietorship
If married, should spouse’s name appear on license? Yes No (If you answer No, you must still enter the
spouse information in section “3f” below.)
b.*Business Open Date
MM DD YY
/ /
Provide the ownership structure’s rst date of business at this location. Out-of-state businesses should
use the rst date of operation in WA. (Required. If unknown, please estimate.)
City State Zip code City State Zip code
d.
*Business Mailing Address (Street or PO Box, Suite No. do not use builiding name) *Business Street Address (if different than mailing) Do not use PO Box or PMB
BLS-700-028 (9/4/19) PAGE 3 OF 4
a. Are you an out-of-state business with no Washington location and have employees or representatives working in Washington?
Employees:
Yes No Representives: Yes No
If yes, provide one of their Washington addresses (we will not use this address for mailing purposes):
Business Street Address (Do not use a PO Box or PMB Address) City State Zip code
j. If you have ever owned another business, provide: ________________________________________ ____________________
Business Name UBI Number
4. Location / Business Information
k.
Provide your bank’s name: ___________________________________ Branch: _________________________________________
f. Did you buy, lease, or acquire all or part of an existing business? Yes No
Date bought/leased/acquired: ____________________________ ___________________________________________________
MM DD YY Prior Business Name
________________________________________________________ ___________________________________________________
Prior Owner’s Name Telephone Number
/ /
( )
g. Did you purchase/lease any xtures or equipment on which you have not paid sales or use tax? Yes No
If yes, indicate purchase or lease price: $ __________________
h. If this business is owned by, controlled by, or afliated with any other business entity, provide that business entity’s name and UBI number:
________________________________________________ __________________________________________________________________
Entity Name UBI Number
________________________________________________ __________________________________________________________________
Entity Name UBI Number
i. If you are changing your business structure (such as changing from sole proprietorship to corporation) and want the
old account closed, provide the UBI number to be closed: __________________________________________________________
Do you wish to cancel all the trade names registered under the old UBI number?
Yes No
You must re-register all trade names you use under the new business structure.
If you plan to have employees or wish to register for elective coverage for owners or excluded employees, complete Section 5.
(For information see the Industrial Insurance or Unemployment Insurance sections on the Endorsement Fee Sheet.)
c.*Provide the estimated gross annual income in Washington (check the one box that applies to your business):
$0 - $12,000 $12,001 - $28,000 $28,001 - $60,000 $60,001 - $100,000 $100,001 and above
e.*Describe in detail the principal products or services you provide in Washington State:
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
d. Mark the business activities in Washington State (check all that apply):
Wholesale Retail Manufacturing Services
b. Do you plan to hire independent contractors or people you will report on a 1099 form? Yes No
Check “Independent Contractors” denition at www.lni.wa.gov/IPUB/101-063-000.pdf
BLS-700-028 (9/4/19) PAGE 4 OF 4
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 rm 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 Date
a. *Date of rst employment or planned employment at this location: ________________ First date wages paid: _________________
MM DD YY MM DD YY
b. Number of persons you employ or plan to employ at this location (do not include owners): _________________
c. *Estimate the number of persons under age 18 (minors) you will employ in the next 12 months and duties they will perform:
Number Duties to be performed by minors (Check www.teenworkers.lni.wa.gov)
Ages 16-17: __________ ____________________________________________________________________________
Ages 14-15: __________ ____________________________________________________________________________
Under age 14: __________ ____________________________________________________________________________
Before checking under age 14, please complete required documents. See publication F700-118-000 at https://www.lni.wa.gov/Forms/pdf/F700-118-000.pdf
d. Check the ONE box which best describes the major operation of your business.
  (
01) Drywall Operations
 
(05) Maritime/Vessels/Longshore
(09) VehicleSvcs/Transportation
(13) Retail/Whlsl: Stores & Warehsing
  (
02) Logging/Forestry
(06) Electronics/Utilities/Vending Mch
(10) Mfg - Chem/Textiles/Paper
 
(14) Food Svcs/Chore/Asst Lvg/Janitor
  (
03) Construction/Engrg/Property Mgmt
(07) Wood Prod/Stone/Glass & Mining
(11) Mfg - Food/Ice/Beverages
 
(15) Media/Entertainment/Lodging
  (
04) Temp Help Co/Employee Leasing
(08) Mfg - Metal/Mach Shops/Millwright
(12) Agriculture/Farming
 
(16) I.T./Prof Svcs/Med/Salon/Schools
e. Describe in detail the activities of your workers. Then estimate the total workers’
hours for a 3-month period. (One full-time worker = 480 total hours for 3 months.)
f. If you have more than one Washington location, how do you wish to receive the following quarterly reports?
Unemployment Insurance: All locations combined Each location separately (multiple reports)
Workers’ Compensation: All locations combined Each location separately (multiple reports)
g. If you are a prot corporation, do you want unemployment insurance coverage for corporate ofcers?
Yes – Go to esd.wa.gov to obtain a Voluntary Election form. This form is required for coverage.
No – The corporation must inform ofcers in writing that they are not covered for Unemployment Insurance.
h. Do you want workers’ compensation coverage for owners (sole proprietor, partners, corporate ofcers, LLC members/
managers)?
(In an LLC with managers, you may elect to cover those persons who are both members (owners) and managers. In an LLC
with members only, you may elect to cover those members.)
Yes – Prior to coverage, Form F213-042-000 is required. This form will be sent to you by the Dept. of Labor & Industries.
No
i. Do you want elective workers’ compensation coverage for excluded employment? (See Endorsement Fee Sheet for descriptions.)
Yes – Prior to coverage, Form F213-112-000 is required. This form will be sent to you by the Dept. of Labor & Industries.
No
X
____________________________________________________________________________ __________________________________ _______________________________
Application Prepared By (Please Print) Title Telephone No. Date
Some agencies can provide language assistance. Would you like assistance?
Yes No Specify language
/ /
( )
/ /
5. Employment / Elective Coverage
5a and 5e are required if hiring employees and/or minors
6. Signature Signature of sole proprietor or spouse, partner, corporate ofcer, or limited liability member/manager.
Employment accounts cannot be established unless you plan to employ persons within the next 90 days. If accounts are
established, Employment Security and Labor and Industries reports will be required quarterly even if you have not hired.
Additional Coverage is available as noted below. (See Endorsement Fee Sheet for more information.)
Workers’ Hours
(Include Minors)
3-Month Estimate
Example: Ofce Staff - reception, accounting, data entry
2
960
/ /
/ /
Number of
Workers
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Completed 15 July 2020

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