2131 MCDOUGALL AVE 2022-05-03 - Laserfiche WebLink

44Backwater Prevention Device Rebate Program Rebate Application Form Property Owner Name: y L ✓/R Installation Address: a.boa d .q ✓�Y)y� __ - _ City: CyeYe7 ---State: zip: 98oZ 0/ Mailing Address (if oifferent): City: State: Email:Phone:(5.U) 776403% Total Cost to Install Device (from contractor invoice): $ :3 0 SS. 7/ Please verify the following g2aS NN 4� -�— �r0 �� O'J'Cf �c 1 am the owner of the property where the backwater prevention device was installed. 1Noe,-, I worked with the contractor to determine the location for the backwater prevention device and understand that the decision regarding the location of the device was mine. X My contractor instructed me how to access, inspect, and maintain the device. I understand that I am responsible for maintaining the backwater prevention device and keeping it in good working order, unless it is installed in the city right-of-way.2>w ece is i hs r¢r// d r cl fy vi �f-,� u/ ® If I sell my property, I will make potential buyers aware of the backwater prevention device add / the need to inspect and maintain it on a regular basis. I am enclosing al; of the necessary paperwork (use the yellowy Rebate Submittal Checklist). Select from the following: ❑ The contractor id:ntified downspouts or other drainage (lines that were connected to my sewer line (between my house and the installed device) and removed, or rerouted them. ❑ To my knowledge, my property has no downspouts or other drainage connected to my sewer line (between my house and the installed device). ❑ There are downspouts or other drainage lines connected to my sewer line (between my house and the installed device). I understand that leaving these connections creates a risk of flooding and I accept that risk. Signature. Date i �