Laserfiche WebLink
I <br /> i <br /> Contractor Section: � <br /> -- I I <br /> C.;'S Pt JhiB NG 6 SENVI(:E LL:: �G02 950'17 � <br /> Vendor Name !Busmess Name/ UBI N�.mber <br /> IGJSPLPS9'S7; __— __ ._ —_--___ _. _ ._ .__— - <br /> S�ate o'VJashinoton Contractor License Nurnber � <br /> � <br /> 55.82181NAVFNf GIIAF.IiC �ALLS 1:'A 98257 f <br /> Vendor tvtatling Nddress City St�'e Zip <br /> t <br /> 16ib5o!-5159 �:15�, UL'HII.G�:LISV i;OM1I � <br /> Phone ---- -- Ema�l I ! <br /> - - --- J I <br /> � <br /> i, Ihe Venaor, auree to rece�ve Ihe Back�vater Prevent�on Dewce rebate check dueclly for the � <br /> �nsta!lation at Ihe abo:e referenced property address Ny agree�ng to receive Qie rehate r.heck <br /> durc��iy, I agrcc to the following <br /> 1 The dackwa;er Prevenbon Uewce rehate amoun; w�ll be derlucted hnm ihe lmal invoice ' <br /> g�ven lo fhe property o�vner fnr thc rostailaLnn at th� property �Ad•nss retererced ahove d � <br /> �he total cost of Ihe installat�cn is yreater than !hc roba�e � <br /> : i the Vendor, am a 1Nashington Slate licensed con'rar.t�r { <br /> 3 ?hn Cdy ot Fverell �vdl send . FeAeral Funn 1099 �v11SC to me, ihe Vendnr, foi R++�:k�vater ; <br /> f'irvenl�on �evicr, rebale payrnenis tnta6ng more than $600 per r,alendar year, ancl wil! i <br /> rc��o�t tl�e sarne paymcnls to the Intern�l ltevr.nue Serv!ce � <br /> -- --_ . . --- - — , <br /> I acc.ept the payment ol lhe El�ickwater Prevenbe,n Dewce �ebate trorn tlie City of Fverett penuuu� , <br /> approval ot Die completeA 13ackwalei Prevenhnn Dewce rebate package by the Cdy of fverett <br /> \ _ i <br /> � \ � <br /> � U )�-- -` _\ S�— 1�— ��-�_ <br /> / <br /> Sigil�ture o nnt clo� Da�c � <br /> ---.. . _. ..—�- - - - --- - � - - '� <br /> i <br /> I <br /> � <br />