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i <br /> Contractor Section: , <br /> — ----- — -- •— .�.—..__ .. ---� ----- --- ..—. i <br /> � � . . _..._ i <br /> `J�---'��r.�?..���:Li:e!�—��.�" � , i; '1 i.�? %i—'� %Q L� ' <br /> Vendor Name ?3usir.< o — �' ��"— <br /> � ss Nam_ /U91 FTunbe� � ; <br /> I <br /> � �Lwe + l_.�-. ' <br /> '--- i'� �.i t^:1 � <br /> � <br /> Stete of Vdasi�ngtr.n Cantrz�tor License Nurnbe- i "^"` . I <br /> ^ � l <br /> � _ .. ' �. ' ✓`T�L)_ ��'1�.i�1 ��I G /,� <br /> Vendor p1�ilinq Addr�se � ���y`�' '�V � � , <br /> Cili 'g�ate L � <br /> u <br /> � � �. <br /> �� 8_iu...�u.Z�i._��J��c�-�_S�.�e�r.�di� arn I . <br /> . Emal <br /> i. ene Ventlor. agree t�recelca thz 6?r.kwatur Prai�enfion pevrw ;snate checA d�reniy for ine <br /> Installation 3t;he arove r5fere^r,ny,�oo2rtg acdrsss By agr�ging to reroive ;he�epate ch¢[k <br /> dlrectty I aqree to t�=fo�lowi�g . <br /> 1 i hC BBCiNl3te�Prev��t on �gy�:C 2ya�� 3mOL"1]�Vdl SB d@•7U��00 I.'07 ih8 in0� jlIVO.CP � <br /> :�rvon to thE propQrly��vaer(or thc ir,staiiaUon ei;r.e prcoeny address reforenced atove. i! � <br /> �ne bfal mstol the Insa;laL'cn !s Greace,-;na„�nE reba:�, <br /> 2 i, Ihe Ver,dor.2m a���ashing�o�Stale i�carsew oontr3olor • <br /> 3 The Ciry o(Eve�eC w�ll 5end a Federel Fo-m 7098 MiSC to n� ihe Verdx `ur Beckwaler � <br /> Prevention Je�ire rebale oaymspis teta:ing rr,�re lhan 5600 p?r celarcar year antl r�ill <br /> report ths sare paymarls b tb= Intsmal?,;�•En�P�en+ir_e ' <br /> � I accept the payment ef the Backw3i�r hrevam�cn Deoice reo�ite.`r�r tke.^.dy e,�verett oending ` <br /> � approral o!ths corrpleted Backwater prevem�.�n pevr.t reba�p p��kgqr �y���, Qty o;Everelt I <br /> �� r i � <br /> _�;�J I � <br /> -�._._ �. .�� . <br /> Si9na�urs cf Con(racicr i�—"' "-- <br /> ! Dal� � <br /> -- --- � <br /> -- -- — -- ------ — -- — ..--- — — _.�� <br /> I <br /> f <br /> i <br /> 5't''b�d iOLb 652 526����d SP�£I ST02-82-Nyf '. <br />