Form Rev 81 1023e - Corporate Headquarters Application For Sales And Use Tax Deferral - Washington Department Of Revenue - 2013 Page 2

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Business Activity to be Conducted at this Facility
Estimated Investment Project Costs
If additional space is needed to answer questions 1 and 2, please
5. Structure:
attach additional pages.
Date construction/expansion to start
1. Describe the nature of your activity at this facility.
Construction of new structure(s)
Leasehold improvements paid for by
applicant
Expansion or renovation to expand
Yes
No
floor space or production capacity
2. Is the investment project located in a
Total Structure Costs
Community Empowerment Zone (CEZ)
as defined in RCW 43.31C.020?
6. Estimated completion date
3. Will you have 300 or more employees at
Employment Information
this facility?
7. Average employment in the state:
(1820 annualized hours worked = 1 FTE):
For the prior year. (# of employees)
Apportionment of Structure
For new employment related to this
project. (# of employees)
4. Percentage of facility devoted to:
8. Estimated average annual wages of
Accounting/Payroll
%
employees related to the project: ($)
Administration
%
Cafeteria
%
Common Areas
%
Conference & Training Rooms
%
Customer Service
%
Manufacturing
%
Packing or Packaging
%
Plant offices used by direct line
supervisors or other managers who
oversee the manufacturing process
%
Processing
%
Reception Area
%
Research & Development
%
Sales & Marketing
%
Warehouse
%
Other (please describe)
%
Total
100 %
REV 81 1023e (5/14/13)

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