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Contractor�ection: <br /> ISG'V�,'-C.-�r�Y' i E'.Y�(1 , .,� L lr C � �l C Z P 3� ��� j <br /> Vendor Name 18usiness Name/U51 umber , � <br /> 1J <br /> �v`.v�y" � 1 C}1 ��, `�� S I <br /> S!ata of Washinaton Coniractor�icen� Numbsr: � <br /> I � <br /> �t� �X �-1-f� L.���r,ti�r�_ •V' G�_$`��1(� j <br /> � Ventlor Mailing Address City State Zip ' <br /> I , <br /> ��0 8�t�i_!-}-7 S �u��w �we,r��i�h��fv.[�pm I <br /> I Phons Email � i <br /> � <br /> � ! <br /> I, t'ne Venoor,agrco to recolvo ihe Sackwatsr Preventior. ��vice feoate check direcUy tor[he <br /> in;�allation at ine above reierenced propery addrEss. By agreeing to receive the rebaie chsck <br /> direc;ly, I a�re�to t�e iollowlnr� <br /> �. 7he 8aci�vater preventiun Duvice rc�baie amoun!will be daducted from the final invoice <br /> given to the properiy owqer for the installation at thc proper?y address referenced above,i( <br /> th� total cost of�he inshaliatien is grnater than th¢�bate. <br /> 2 I, the Vendor, am e'vVashinylon State licensed contrgctor. <br /> 3. The City of Everett wiil send 2 Federal Form t099 MISC lo ma, the Vendor, fot Backwater <br /> Prevention Device rebata paymetits lotaling more t!ian Sf00 per calendar year, and ,vi!! <br /> report the c2m�paymenx to the Intemal Revenee Sorv!co. <br /> �� �ccept ihe payma.n!n�the BacAtivater Prevention Device rebate from �he City of Everetl oendinp I <br /> Iappreva!o!the cempieted Bacicv�aler PrevenGor.De�d;e r_bate pa�<�ps by ths Clty of E�rere;: I <br /> � �-, �MaS��n,.,� 4�-e.�c.-,�,�• `^�c�-a,,u,� i <br /> . i���,� ' ,�� � <br /> .e � �o -- ! <br /> ,.' � S)�na!ure oi Centrac!or p_je i <br /> � i <br /> I <br /> I <br /> � <br /> 90 39bd 56�0 � 531dV1S b5�0I ST@Z/O1/LO <br />