Laserfiche WebLink
i <br /> � <br /> , <br /> � <br /> i <br /> i <br /> � <br /> � <br /> , <br /> Contractor 5ection: � <br /> � i <br /> i /,al;il i.0 L�Lltit/i' - 4' (�� -ri/ 3 - USS'� i <br /> � Vendor Name I Business Name !UBI Number � <br /> i <br /> ' � ' �G �'� �c''' � 4 <br /> State of Wesnington Contractor License Number. f <br /> i <br /> S`�ri7 7/j~/�i/; N�. M./�1ZYSilLI�= W/) y',�f� �� � <br /> Vendor Mailing Address Cily State Zip � , <br /> { � <br /> �"��.S� 5�57 "1,�07 � � <br /> Phone Email i <br /> � <br /> ! <br /> I, lhe Vendor, agree to receive the Backerater Prevention Device rebate check directly for the i <br /> inslallation al the above re�erenced prope�y addr255. By agreeing to receive the rebat= check � <br /> directly, I agree to the tollo�ving: i <br /> 1. The Bachtvater Preveniion Device rzbate amount will be deducted from the fina! involce � <br /> i <br /> oiven to the property oerner for the instaflalion at the prop2rty address referenced above, if � <br /> the total cost oF lhe installation is greater than the rebate. � <br /> 2. I, the Vendor, am a Washington State iicensed contractor. � <br /> 3. The Ciry of E��erett aill send a Federal Form 1099 MISC to me,ihe Vendor, tor Backe�ater ! <br /> Prevention Device rebate payments totaling mor2 than 5600 p=r caiendar year, and a-il{ i <br /> report the same paymznts to the Internal Revenue Service. j <br /> (�—'_ � <br /> I acczpt the payment of the Backwater Prevention De��ica rebate from the City oi Everetl pending I ' <br /> 1 approval of lhe compieted Backwater Prevention Device rebate package by the Cily of Everett ; <br /> i � <br /> � i <br /> � � <br /> I <br /> %/9/� � <br /> Signature of Contractor ----.. Date � <br /> — ' � <br /> i <br /> � <br /> I <br /> i <br /> i <br /> t <br /> � <br /> i <br /> . i <br />