Laserfiche WebLink
� � � ��o��[�c��� �r1vo� ce G�s-� ��e�ck��o�n1 <br />� <br />P ase use t is Invoice Cosl Dreakdor�n as a template for invoices submitted as part of 1he ac water <br />Prevention Device rebate program. Edner lhis form or your own invoice form ���ith tho following line items ca� <br />be submitted. This allows you to invoice your �Ilent according to your existing billiny template while allowing <br />city sfatf to idenNfy 11ow Costs eligible for the Backwater Prevention Device Rebate were accruad. <br />Onfy fabor and materials dlrectly related to the instaflation and fimction of a backwater prevention <br />device are ellglble for' City rebate and therefore shoufd be includad on ihe upper half of thrs form. <br />Atldldonai costs ma}� be added to bottom of the form. <br />Business Name:�'_�i� o� cu�c�X�«k __ License �umber:/-�vs��sv /-�'.�S <br />Business i��idif�ng Atldress �l1LS��b�i�����J_� �^��S �• �8�a6 <br />//� /�I/ City p Stale �+� Z��p . . <br />Phone:_ �" - v—f l�� __ Email:Yll�r"�w��S�o2,�� Av�cYSG_'K1� �1�"�u r. Go�� <br />�-Labor — <br />� <br />t- <br />I �9atcrials <br />I � <br />l- -�._. <br />I <br />� <br />�-- <br />I Rentals <br />F--- <br />� Fces <br />Eliqible Total <br />OQier Costs <br />�nofiqibic Tofa� <br />Total <br />CCTV In;pE <br />BV�N InstaU <br />Bac'tr:a,er valve <br />Gr:nder pu� <br />Side sewer pipe (up l0 8 feet) <br />hnported Backiill �� <br />Surface Resroration ��iateria!s <br />to � soil grass seed. concrete <br />Cover (irrigalion box nr load b <br />Hours <br />Hours <br />Hours <br />Heurs <br />Hours <br />Ho�ars <br />Yards <br />Per <br />Disposal (ces by item _,___�.__ � Ta�u' � <br />Delivery fces i( not covered by labo�_ __ __ � <br />— - — - _ ------ -- l <br />- I <br />Costs not assoaaled vn�h BWD, and I <br />nol eli ible for rehale (detail helov�.�_,.,, ___ <br />Revised 9;03�?01�# <br />� <br />�u- <br />V <br />�rI�7 <br />�-_ __ _I _ - — - <br />-j1�0.� � ��— <br />---..__ __ �� . ��.t%dR— <br />--- -- ---- _ � l d" --- <br />i s <br />