Laserfiche WebLink
Contractor Section: . <br />�-Y�i''�Cc�t=D—��� �'d��cc�l; LLG ��%� , t`t-y'.3 <br />Vendor Name! Busine s Name / UBI Number � <br />�1�P_;�-�-�►-i��- -- <br />State of Washington Contractor License Number: <br />�(���n_ L4L�i�__Q$ E.lJ�cE�"�__i, q <br />�''�`� a�0� <br />`lendor Mailing Address Ciry Slate Zip <br />Phone Email <br />I, the Vendor, agr�e lo rer.eive ihe Backwater Prevention Device rebate check direclly for the <br />installalion al the above referenced properly address. Qy agreeing to receive the rebale check <br />directly, I ac�ree lo the following: <br />t. The 8ackwator Prevention Device rebate amount vrill be dedu�t�e�d�e smefer nceld above, if <br />given lo Uie property owncr tor Iha installotion ot lhe property . <br />tho tolal cost oi the installafion is r�rea[er than th� rebate. <br />2. I, lhe Vendor, am a Washington Slate licensed r.onlractor. <br />Tho City of Everott will send a Pedciol Form 1099 MISC lo me, Ihe Ve�dor, for Backwater <br />Prevenlion Dovico rehalo paymenlc toialing more than 5600 por calendar year, and will <br />report the same payments lo the Intemal Revenue Service. <br />� <br />I accepl the payment of lhe flackwaler Prov�nlion Device rebale from lhe Ciry of Everelt pending <br />approval of ihe completed Backwaler Prevenlion Devir.e �ehale package by the Gly of Fverett <br />C��—����.e�-�— _- `�-.�✓4� <br />Signalurc of Contraclor Dale <br />