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2. Last Name
3. First Name
4. Middle Initial
6. Address1
7. City
8. State
10. Zip
11. Home Phone
12. Drivers License #
13. Date of Birth
    mm/dd/yyyy
15. Place of Birth
    City & State
16. Social Security #
18. Business/Company Name
20. Street Address
21. City
22. State & Zip
24. Business Phone
25. Business is
    -- Select One --Single OwnerPartnershipCorporation
27. List other permits/licenses required to operate business in the State Of Washington
29. Washington State U.B.I (Tax I.D.)#
    Please attach a copy of Registration with Washington Department of Revenue)
30. State Returns Filed
    -- Select One --MonthlyQuarterlyAnnually
32. Note:
    Addresses of applicant for five years immediately prior to date of application.
34. Street Address
35. City
36. State & Zip
38. Street Address
39. City
40. State & Zip
42. Street Address
43. City
44. State & Zip
46. Street Address
47. City
48. State & Zip
50. Street Address
51. City
52. State & Zip
54. Note:
    The total retail sales tax to be collected in the City of Port Angeles is 8.4%. The local tax portion will be rebated to the city of Port Angeles according to the information you report on your tax return under City of Port Angeles Tax Code 0502 for sales tax collected in Port Angeles.
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