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02/23/2006 16:23 FAX 425 257 8741 CITY OF EVERETT Igel 001/001
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<br /> - CITY OF EVERETT
<br /> Business Tax Division BUSINESS TAX NUMBER APPLICATION j0.9,11,-----
<br /> 2930 Wetmore Avenue (Business License)
<br /> Everett,WA 98201
<br /> {425 257-8610 F132
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<br /> COPY
<br /> FILE APPLICATION AND$10.00 FEE WITH BUSINESS TAX DIVISION, CITY HALL
<br /> FIRM NAME
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<br /> ' BUSINESS LOCATION(-/Short Number,My,,Stale,Apt.,Stale) ar e� /�
<br /> Zte 7� k...)Z tt `o st 1 w.4 'Z.-( 11 4.10' r"email `1Q; 1 .Cd''� ZIP CODE
<br /> MAILING ADDRESS(Street Number,011y,State,Apt.,Sulfa) ZIP CODE - .
<br /> %112o I.a+k A.A. 1- tr,zc.'
<br /> REASON FOR FILING THIS APPUCATION NAME.FIRM NAME 6 ADDRESS OF PREVIOUS OWNER ACCT.NUMBER
<br /> ,Z 0 Inoorporaw,g CI Change of Ownership
<br /> Existing Business of Existing Business
<br /> XStertirg New Business CI Change In Corp Entity
<br /> DATE OF FIRST BUSINESS ACTIVITY MONTH/,DAY/YEARFEIN(Fed.Emp,ID No.) UBI(WA Slate Dept,of Revenue)
<br /> 3 IN EVERETT BY THIS ENTITY / —3 1 —a _"C 1 S 7—
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<br /> NATURE OF AReteff O Manufacturing . IF CONSTRUCTION,SPECIFY TYPE O ResiderWW O*limey 0 ConsaercIul O Spa:Waive
<br /> BUSINESS X Wholesale 0 Service 0 OTHER.PLEASE SPECIFY
<br /> 4 DESCRIBE IN DETML PRINCIPAL PRODUCT O(R�SERVICE RENDERED IN EVEREtTT PIAN 1-r h,�,aJ J(. r+•o 4 t,q.a ren,, rt to irC1�ri
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<br /> OWNER'S LAST NAME Ft STRM LE SPIT DATE Al.SECURITY NUMBER(OPTIONAL) S.
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<br /> 5 ,T SPOUSE A FIRST MIDDLE SIRTHOATE SOCIAL SECURITY NUMBER(OPTIONAL)
<br /> fNDNwUAL SA, ike'VS &t, l 411.(ki
<br /> OPERATED BY HUSBAND AND WIFE?
<br /> C 0 YES )iitNO
<br /> H FIRST PARTNER'S LAST NAME FIRST MIDDLE BIRTHDATE SOCIAL SECURITY NUMBER(OPTIONAL)
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<br /> )( cji SECOND PARTNER'S LAST NAME FIRST NICOLE BIRTHDATE SOCIAL SECURITY NUMBER(OPTIONAL)
<br /> . PARTNERSHIP
<br /> THIRD PARTNER'S LAST NAME' FIRST MIDDLE BIRTHDATE SOCIAL'SECURITY NUMBER(OPTIONAL)
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<br /> 0 FULL LEGAL NAME OF CORPORATION
<br /> P
<br /> L NAMES OF CORPORATE OFFICERS NOME ADDRESS CITY,STATE PHONE
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<br /> E la HOME ADDRESS. CITY,STATE PHONE
<br /> . 0 CORPORATION w Pna.
<br /> N HONE ADDRESS CRY.STATE . PHONE
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<br /> HOME ADDRESS CITY,STATE PHONE
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<br /> Treaw.er
<br /> The undersigned certifies that the above information is complete,true and accurate to the best
<br /> of his knowledge. Further,the undersigned certifies that he/she understands that a business tax
<br /> number(business license)is issued for the express purpose of taxation and shall not be construed
<br /> as a license or permit to operate business in violation of any.City of Everett ordinance, rule or
<br /> 6 regulation. It is the undersigned's sole responsibility to ensure compliance with ail applicable
<br /> City ordinances,rules and regulations prior to conducting business in the City of Everett.
<br /> APPLICATION SIGNATURE E DATE SIGNED
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<br /> HOME PHONE
<br /> iffiliiiiiiiille
<br /> �1 HOME ADD
<br /> LICENSE ISSUED LOCATION CODE SIC NUMBER 550 ACCOUNT NUMBER
<br /> 7 TR
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