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WENTWORTH MFT PLLC - ADDED 2020 1031 Date:Oct 14, 2020Page: 1 In City Limits:YesEndorsement Status:PendingStatus Reason: Location Information Business Structure: Limited Liability Company UBI Number: 604609631-001-0001 Legal Entity Name: WENTWORTH MFT PLLC Application ID:501895295 Firm Name: WENTWORTH MFT PLLC Application Date:Sep 1, 2020 Location Phone:(360) 901-2988 3609 Fees:35.00 Location Fax: Expiration Date: Sep 30, 2021 Email Address:WENTWORTHMFT@COMCAST.NET Business Open Date:Jun 1, 2020 Location Address: 10501 CREEK ST SE STE 2 YELM WA 98597-9805 Mail Address:706 GROVE LN RAINIER WA 98576-6300 Product/Serv Description: Mental Health Counselor. City Endorsement Information Previous Business License: Number of rental units: 0 Interior/Exterior Modifications: Yes General Specialty Contractor #: Square Footage: 90 Gross Income:$5,000.00 Number of full-time employees at this location:1 Number of part-time employees at this location:0 MG60578577 WA State professional/occupational license:Marriage & Family Therapist Associate Conducting Business From Residence:No Customers Visiting Premises?NoPer Week: 0 Business Activities: Hazardous Materials: Smoke Detect/Fire Sprklr (360) 901-2988 Emergency Contact 1:JENNIFER WENTWORTH Emergency Contact 2: Alarm Monitoring Service?No Company: Contact: Contact Phone: Previous Business Owner?NoName: Firm name: Yelm General Business604609631-001-0001 Date:Oct 14, 2020Page: 2 Phone: Other Location Endorsements Approval Information Zoning ___________________________________ Fire ___________________________________ Date Date Building ___________________________________ Police ___________________________________ Date Date Finance __________________________________ Planning __________________________________ Date Date Comments: Yelm General Business604609631-001-0001