Fillable Printable Architect Firm Addendum
Fillable Printable Architect Firm Addendum
Architect Firm Addendum
State of Washington
Business Licensing Service
PO Box 9034
Olympia, WA 98507-9034
1-800-451-7985
UBI
Owner name (Please print clearly)
Architect Firm Addendum
Failure to complete the entire addendum will cause a delay in processing your application or renewal.
A Registered Professional Design Firm Certicate of Authorization is required for any rm practicing or offering to practice
architectural services in Washington. Each Architect Firm must have at least one Designated Architect.
Please select one:
New Application/ Certicate of Authorization – Must be submitted with the Business License Application. ----- $278 fee
Change or Add an additional Designated Architect – Be sure to include your UBI and Owner name above. --- no fee
A Designated Architect:
• is responsible for all nal architectural decisions on behalf of the rm with respect to work performed by the rm in
Washington State.
• must be a governing person and hold a position of responsibility within the business structure.
• must be registered to practice in Washington State.
Designated Architect information - complete one form for each designated architect
Designated Architect name (First, Middle, Last) Architect registration number
Requirements
You must conrm statements 1 and 2 by marking the “yes” box. If your rm is a Corporation, you must also conrm
statements 3 and 4.
The Designated Architect named above is one of the following:
• a partner for a Partnership or Limited Liability Partnership.
• a manager for a Limited Liability Company.
• a director for a Corporation or Professional Service Corporation.
• a ___________________________________ for an ownership structure not listed above.
Provide the title
1. He/she has been notied of his/her responsibilities and obligations involved with serving as
the Designated Architect for this rm. ........................................................... Yes
2. I understand this certicate of authorization is based upon the current architect registration(s)
of the Designated Architect(s). If the registration(s) of the Designated Architect(s) should become
delinquent, I understand that the rm’s certicate of authorization is invalid. ............................. Yes
If your rm is a Corporation, please conrm 3 and 4:
3. Our resolution states that the Designated Architect named above is the Designated Architect
of this rm. ................................................................................ Yes
4. Our by-laws state all architect decisions shall be made by the Designated Architect responsible
for architectural activities of the rm. ............................................................ Yes
Remove Designated Architect – attach additional sheets if needed
Name of Designated Architect to be removed (First, Middle, Last) Architect registration number
As the applicant or authorized representative of the rm completing this application, I have read the requirements and
certify under penalty of perjury under the laws of the state of Washington that the requirements have been met and the
foregoing is true and correct.
_______________________________________________________________ _________________________________________________________________________
Date and Place Signature of applicant or authorized representative
_______________________________________________________________
_________________________________________________________________________
(Area code) Telephone number Print name
BLS-700-181 (07/07/17)
X
For tax assistance or to request this document in an alternate format, please call 1-800-647-7706. Teletype (TTY) users may use the Washington Relay Service by calling 711.
Click here to START or CLEAR, then hit the TAB button
