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i � <br /> . i � <br /> 1 <br /> i <br /> i <br /> . j <br /> Contractor Section: ; <br /> 1 <br /> i <br /> CJ'S PLUM�ING 8 SERVICE LLC/602 950 117 i <br /> — i <br /> Vendor Name/Business Name/UBI Number � <br /> i <br /> CJSPLAS9150D � <br /> State of Washinglon Contracror License Number: � <br /> 5528218TH.AVE NE GRANITE FALLS WA 98252 <br /> Vendor Mailing Address City State Zip <br /> t <br /> 3fi0-691-5159 CJSPLUtJC11NG6M5N COM j <br /> Phone Email � <br /> _— � � <br /> — _ -- � <br /> I, the Vendor, agree to receive the Backvoater Prevenlion Device rebate check directiy for the j <br /> installation at the above referenced property address. By agreeing to receive the rebate check ( <br /> direclly, I agree to the following: ! <br /> 1. The Backwater Prevention Device rebate amount will be deducted irom the final invoice � <br /> given to the property o�vner for the installation at the property address referenced above, if � <br /> the toial cost ot ihe installation is grealer ihan the rebate. <br /> 2. I, the Ve�dor, am a Washington State licensed contractor. I <br /> 3. The Cily of Everelt will send a Federal Form 1099 NISC to me, the Vendor, (or Backwater � <br /> Prevention Device rebate paymenls totaling nwre than 5600 per calendar year, and will ; <br /> report ihe same payments to Ihe Inlernal Revenue Service. a <br /> i <br /> 1 <br /> I accept lhe paymenl oi ihe Backwater Prevention Device rebate from the City of Everett pending� � <br /> approval ot the completed Ba�kwater Prevention Device rebate package by the City of Everett � <br /> I <br /> I <br /> i <br /> �-" f� US�z�'� �� � <br /> i <br /> Signalure of CoNr or Dale � <br /> . � <br /> -- - I <br /> I <br /> � <br /> , <br /> i <br /> , <br /> � <br />