Laserfiche WebLink
Contractor Section: <br /> -��va :nlwm-��i,� C�v�- vl3 =S.?��— i <br /> Vendor Name 1 Busi�iess Name I'UBI Number � <br /> . � <br /> _��LL �L 1`�i L_-- <br /> State of Washington Contractor License Number: <br /> i <br /> �u b 7 7 Is-1 �K oVc'' ���' u� �I��,,�y. �sr�-�C�— <br /> Vendor Mailing Address Cit� State Zip <br /> ua� 3g7- I SZ�� — - — <br /> Phone Email <br /> i <br /> I, the Vendor, agree to receive the Backwater Prevertion Device rebate check directly for the <br /> installation at the above referenced property address. By agreeing to receive the rebata chech <br /> directly, I agree to the following: <br /> 1, The t3ackwater Prevention Device rebate amount will be deducted from the final inveice <br /> given to thc property o�vner for the installation at the property address reterenced above, if <br /> the total cost of the installation is grealer lhan the rebate. <br /> 1. I, the Vendor, am a Washington State licensed contractor. <br /> 3. The City of Everett tvill send a Federal Form 1�99 MISC So me, lhe Vendor,for Dackwater <br /> Prev�ntion Device rebate payments lolaling more than 3600 per calendar year, an�vrill <br /> rep.�rt tie same paymenls to lhe Internal Revenue Service. <br /> i ---- -- -- — --- � <br /> II accept the payment of the Backwater Preveniion Device rebale from ihe Ci,y oi Everett pending � <br /> i approvai of the compl�ted Backtvater Prevenlion Device rebate package by the City of Everelt <br /> � (o - IZ i� <br /> Signature f Con�ra6lor Date <br />