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CITY OF EVERETT <br /> Business-tax Division BMMLLIS TAX NUMBER APL Q SII ON <br /> 2930 Wetmore Avenue (Business License) <br /> Everett,WA 98201rr <br /> (425)257-8610--t <br /> Fax:(425)257-8741 <br /> FILE APPLICATION AND FEE WITH BUSINESS TAX DIVISION, CITY HALL <br /> FIRM NAME BUSINESS PHONE <br /> )P n 2 <br /> BUSINESS LOCATION(Street Nu ber,City,Slate,Apt.,bultsmall address 21P COD <br /> A <br /> MAILWG ADDRESS(Street Number,City,Stafb,Apt.,Suite) ZIP CODE <br /> REASON FOR FILING THIS APPLICATION NAME,FIRM NAME€c ADDRESS OF PREVIOUS OWNER ACCT.NUMBER <br /> 2 B incerporaling C1Change df Ownership <br /> ` Existing Business of sting Business <br /> ❑Sterling Now Business 13 Change In Corp.Entity <br /> DATE OF FIRST BUSINESS ACTIVITY MONTH!DAY/YEAR FEIN(Fed.Emp.ID No.) / ©© U I(WA State D/�L of Revenue <br /> `3 IN EVERETTBYTHIS ENTITY �— a��3 1 '/b� v�� ' <br /> NATURE OF • ❑Retail ❑Manufa0uring IF CONSTRUCTION,SPECIFY TYPE Xpesidential ❑Highway ❑Commercial ❑Speculative <br /> BUSINESS 0 Wholesale ,• Service 0 OTHER,PLEASE SPECIFY <br /> bnCRIBE IN DETAIL PRINCIPAL PRODUCT OR SERVICE RENDERED IN EVEREtT ' <br /> OWNER'S LAST NAME FIRST MIDDLE <br /> 5 ® SPOUSE FIRST MIDDLE <br /> INDIVIDUAL <br /> OPERATED BY HUSBAND AND WIFE? <br /> H ❑YES ❑NO <br /> E FIRST PARTNER'S LAST NAME FIRST MIDDLE <br /> C <br /> K - <br /> ® SECOND PARTNER'S LAST NAME FIRST MIDDLE <br /> PARTNERSHIP <br /> L' THIRD PARTNER'S LAST NAME' FIRST MIDDLE <br /> O <br /> M FU LEG L NAME OF CORPORATION <br /> P <br /> L <br /> E NA SOF 46RPORATEOFFICERS HOME ADDRESS CITY STATE PHONE <br /> T �{ w, `1as1�¢� <br /> E Pres. <br /> HOMEADDRESS CffY STATE PHONE <br /> O COBPgRATION V.Pres, <br /> N OA HOMEADDRESS CITY,STATE PHONE <br /> E LLG <br /> Secretary - <br /> ----- -- - --- HOME ADDRESS-•---------- -- CITY,•-STATE-----------PHONE---- _.—_.- -- - - <br /> Treasurer <br /> The undersigned certifies that the above information is complete,true and accurate to the best of his knowledge. <br /> Further,the undersigned certifies that he/she understands that a lousiness tax number (business license) is <br /> issued for the express perp®se of taxation and shall not be construed as a license or permit to operate business <br /> 6 in violation of any City of Everett ordinance,rule or regulation. It is the undersigned's sole resporisibility to <br /> ensure compliance with all applicable City ordinances, rules and regulations prior to conducting business in <br /> the City of Everett. <br /> APPLICATION SIGNATURE TITLE DATE SIGNED <br /> HOMEADDRESS HOME PHONE <br /> LICSE ISSUED LOCATION CODE NA1C NUMBER B&O ACCOUNT NUMBER <br /> 7 TR SH <br /> *!ATTACH LIST FOR ADDITIONAL PARTNERS) DATABAF,INC. <br />