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CITY <br /> aashingfonStateDp�rtmentof Fees (Check all that apply) <br /> V0 ealth g <br /> New Registration <br /> ❑ Expired Registration <br /> n Duplicate Registration <br /> Check the online fee page for current <br /> fees. <br /> All fees are nonrefundable <br /> Revenue: 0283050000 <br /> Humane Society/Animal Care and Control Agency: <br /> Limited Veterinary Services to Qualified Households <br /> Registration Application <br /> This is for: X New I I Change of Ownership <br /> ❑ Name Change Only — Current Facility Name <br /> Check One <br /> Association ❑ Limited Partnership ❑ Sole Proprietor <br /> I Corporation pc Municipality (City) ❑ State Government Agency <br /> ❑ Federal Government Agency ❑ Municipality (County) I I Tribal Government Agency <br /> I I Limited Liability Company I I Non-Profit Corporation n Trust <br /> ❑ Limited Liability Partnership I I Partnership <br /> 1. Demographic Information <br /> UBI # 313 000 656 Federal Tax ID (FEIN)# 91-6001248 <br /> Legal Owner/Operator Name <br /> City of Everett Animal Services <br /> Mailing Address 333 Smith Island Road <br /> City State Zip Code County <br /> Everett WA 98201 Snohomish <br /> Phone (enter 10 digit#) 425-257-6000 Fax (enter 10 digit#) <br /> 425-257-6023 <br /> Email Address Web Address: <br /> eas@everettwa.gov www.everettwa.gov/animals <br /> Facility/Agency Name (Business name as advertised on signs or Website) <br /> Everett Animal Services <br /> Physical Address <br /> 333 Smith Island Road <br /> City State Zip Code 98201 County <br /> Everett WA Snohomish <br /> Facility Phone (enter 10 digit#) 425-257-6000 Fax(enter 10 digit#) 425-257-6023 <br /> Mailing Address (If different than physical address) <br /> City State Zip Code County <br /> DOH 672-069 October 2014 Page 1 of 3 <br />