1506 ROCKEFELLER AVE 2022-05-11 - Laserfiche WebLink

: . . I RJ. l . 1 �' t..� L � . . . ). � ..1 , . ' v. . . . ' � � {.�: . � . � . .. . . .... .. . ' . . '.'. ... .. ..... . . . .. . '.. ' . I Contractor Section: ! � — i it2.T1 Nl C� L'c�I Lt � 0974 {��u_w��lY� u,L ��Z-7d'Z�l ; Vendor Name/Business Name I UB Number `�` ; /9-tW-f��u Ik'a///%1 � � State of Washington Contrador License Number: ' ; �(p!l (/IS� Va.��2Ct f9�--�L�W,�— �- `�� ' Vendor Mailing Address City State Zip � LI2S=�189-��Z3� � �t4 Lv�, �r�� t � C��nrnL�C n�r� � Phone Emall J . I I,the Vendor, agree to receive the Backwaler Prevention Device rebate check directly for the � installation at the above referenced property address. By agreeing to receive the rebate check directly, I agree to the following: ' i 1. The Backwater Prevention Device rebate amount will be deducted from the final invoice ' given to the property owner for the installa6on at the property address referenced above, if ' the total cost of the installaUon is greater than the rebate. , 2. I,the Vendor,am a Washington State licensed contractor. � 3. The City of Eveiett will send a Federal Form 1099 MISC to me,the Vendor, for Backwaler Prevention Device rebate payments totaling more than$600 per calendar year, and will report the seme payments to the Internal Revenue Service. � ; ! I accept the payment of the Backwater Prevention Device rebate from the City of Everett pending 1 approval of the completed Backwater Prevention Device rebale package by ihe Citybf Everett i , i //�*J.�/�`��.�--r ) 2 �-� � i � , C� � � Signature of Cont2ctor Oate � i I � � f � � � . � � . � . � � I � . . ` . ... i'� . 1 ' ' . ' . .' . - . � . i . . , . . � - . . , . .. . . . . . . -..� .. .. . . . . .. .. .. �. . . .�.. .. . . . . . . . : , . � .. . . . . .. : . . , . f:. . . . �,.� . . . _ . � . - . . . . . . . . . . .. � I i