Laserfiche WebLink
.� .. . i. .... ,.._�. �f . . .� _ .�_._. •-.�.....� <br /> �' . <br /> � ,` 1 <br /> 4� � ' • I <br /> �1 { <br /> [1. I <br /> 1 � <br /> ' Contractor�ectlon: � <br /> i _ �_ <br /> r � <br /> 4 �dor Nam�Business Name I �Number r �� �f.'�,7 L�'] <br /> ; Jv�nl /�5�,�� ' ��c .�/ ��1�-�<< a.�l � <br /> � Stale uf Washinylon Cur Ira � r Li�ense N mber. <br /> . . : � �"��S/'��C L- `1 �v �-�-f� <br /> ; ' , .. Vendar Meilin�Address' � City Stat Zip � 3 <br /> , � . . . . ���. �-�� J.:�� j7'l cc�/f.��:� A� ��8,,�7� + <br /> � Phone . �i` • — � <br /> �i� ' � <br /> ! ' ��� 7��- '" 3 6�7 .�S� ��C�l�:S�2 � 1�'��d� �` �• •�� <br /> � � <br /> I, Ihe Vendor, ,qree to receive tl�e Backwater Prevention Dehce rebate check directly lor ilie ' <br /> instaUadon a1 the above referenced property address. By agreeing to receive Ihe rebete check <br /> dlreCqy, I agrce to the tollowing . <br /> � 1. The Backwater Prevenlion Device rebate amount will be deducted irom ihe final Invoice <br /> j • giv�n to the propehy owner for the installation at the property adAress referencod above, it , <br /> , . th�total cost of tha installaUon is preator then Me rebate <br /> � . 2. I,the Vendor, am a Washington Stete I�censed contradoc � <br /> � 3. The Clry of Everetl will send a Federal Form 1099 MISC to ma, the Vendor, for Backwater ! <br /> „ - Prevenlion Device rebate payments toteling more than 5600 per calendar year, and wlll � <br /> report the eame payments to tho Inlernel Revenue Srrvice. � <br /> �' . . . . . ' I <br /> I , „ — i <br /> ; ; I.accepl the paymenl of lhe Backwaler Prevenlion Device rebate from Ihe City o!Evere�t pending <br /> ' '. approval of Ihe compleled Backwator Provontlon Devlce rebate package by the City of Everelt <br /> , ' . I <br /> i � �-�� ' � <br /> � � - - � � �► � <br /> � ture o , ontr�dor Date ' <br /> ! ' ' ' ` _.. . I <br /> �. - _ <br /> ; .•� ' • • j <br /> � . , � <br /> � . . . • • • i <br /> : . . . .. . � i <br /> ;. ;�, ' . •• , . ,,I <br /> � . • • <br /> i . . . <br /> � .�� " '�t ' ' 1 . • . . , �,;•I <br /> ' . .. `. �. � .� _ ... _ _ ... . ._. .. _�. �-""�--_ .. ._ ..� -` ''- -�_.V_.__—�_...�—_._.._. —�._.__.._.�, _---_—� .-_._.._� <br />