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� <br />Contractor Section: <br />CJ'S PLUPdBIP1G 8 SERVICE LLC / 602 950 117 <br />Vendor Name I Qusiness Name / U81 Number <br />CJSPLPS9150D <br />State of Washington Contractor License Number: <br />5528 21 BTH AVE NE <br />Vendor Mailing Address <br />360-691�5159 <br />Phone <br />GRANITE FALLS WA <br />City <br />CJSPLU�+dB WGC�, MSN.COM <br />Email <br />98252 <br />State Zip <br />I, the Vendor, agree lo receive lhe Backwaler Prevenlion Device rebate chxk direcily for Ihe <br />installalion at the above re`erenced property address. By agreeing to receive the rebate check <br />direcUy, I agree to the follo�ving <br />1 The Backvaater Prevention Device rebate amount will be deducted (rom lhe final invoice <br />given to Ihe property o�vner for the installation al lhe prooerty address referenced above, if <br />the total cost of the instaliation is greater than the rebate <br />2 I, fhe Vendor, am a Washinglon State licensed conlractor. <br />3 ihe City o( Everett will send a Fede.ral Form 1099 MISC to roe, the Vendor, for Backwater <br />Prevenlion Device rebate payments totahng more ihan 5600 per calendar year, and will <br />report the same payments to the Internal Revenue Service. <br />I accept the payment ol the Backwater Prevenlion Device rebale from Ihe Cily of Everelt pending <br />approval of the completed Bacicwater Prevention Device rebate package by the City of [verelt <br />�/� �S <br />Date <br />I <br />q <br />