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Contractor Section: <br /> �----� - - - - -- - ----- — --- -- - -- ----- - <br /> sl ew�:.r �r' i - - L L C � (� 0 2 �13� 7 g D , <br /> Vendor Name 1 Business Nam=I U�r <br /> Sewe�- -� G- �11 l� �m S -- _ _ -- -- <br /> State of Washington Contractor License Number: <br /> �t� �x �15 ��nY�� IN1�-�g0u� � <br /> Vendor 1�lailing Address City Stale Zip I <br /> _Zplo 8�10 -I►-�7 8 �►�.+��e�S�wPr-�ri nc�fv,eQm i <br /> Phone Emait j <br /> i I <br /> I <br /> I, tne Vendor, aaree to receive the 8acfnvaler Prevention �evice rebate check directly ior the <br /> inslallalion at the above reterenced oroperty address. By agreeina to receive the rebate ch=ck <br /> direclly, I aaree to the fo!lo�.ving: <br /> 1. Tne Baclovater Prevention Device rebale amouni will be deducted .'rom the final involce <br /> given to the property ovrner for the inslallation at tha propefi�address referenc�d above, if <br /> the total wst of the installation is grea�er than the rebate. <br /> z. I, li�e Vendor, am a Washinoton State licensed conlractor. <br /> 3 The City o(Everett will send a Federal Form 1G99 fv11SC to me, the Vendor, (or Backvrater <br /> Prevention Uevice rebate payments lotaling more than 5600 per calend2r year, and �•nll <br /> report lhe same payments to the Inlernal Revenu= Service. <br /> I I accepl the payment of the Backwater PrevenUon �evice rebate trom the City o(Everett pendinq <br /> ; approval of ihe completed Bac4n�raler Prevenlion Device rebate package by the City of Everelt <br /> ( <br /> � <br /> !I i� !/ v�,C�['- ���, - <br /> I � <br /> i Signature of Contractor Date <br /> I -- —--- - ---- -- - - - ---- ------ — <br />