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J .�- YA�� - - � :;J .r . } �} ii S5H5� � ��.. . rGw.>a . i <br /> � ' InstallaUon�dd��ss 1620 WeEmore r ti x"� + r"•' kti �+i. � <br /> � ��%.'r � /•' � ��•Y G :��.. , N-C' `� r _.;�,a ��F�`.y y� M N.� i <br /> City. Eveiett State: WA `' �' Zip;98201 •• �.�a. '� � - � <br /> I .. �. . . ,. \ _� rt\ �I� C . . <br /> ` a z + I <br /> ^^..�i���g Address(AdiHerent): ���i'� <br /> . . <br /> ��Ci �` - Slate Zi ' � ` ' ' <br /> b ' ,` P� � �y ,» <br /> .,. t`.�: ,. � k : <br /> Emaii: mikn�nct�llousa(a�mail com• PhOne (425); � � + �k�� <br /> . . , . L ; � t ; , , , <br /> Tolal Cost to In�tall Device(Irom contraclor invofce) $ 2 402 40 _ ��_.; � �Kh v 1 � i <br /> }2 , ' y <br /> ,� _� • • t�:i a ., <br /> .. � � C ', � �. r � ' � = r _-.� n : L .a��1 K'� °LF�� r � J <br /> .._ �'._, �"Q} � . . i � t � . I � �~ r � �r�1 xl n.� '� <br /> ` Please verify,the fo�owm9 ' ' , �1 , ; �" ,ef�,aY�! ^•. ' <br /> . ,� <br /> , � 5�14� {; ..s'��,�"�� "'r��; '� �' ' r - t Y '^ ~ ��r��'�. r 47�'> � . .�xt ` �� <br /> Q I am the oWner of the prop�Ay wh�ere the bacfcwater prevention de3ice, as mstalle�i;� '� � •Q�� � �� I <br /> � �1 � � ��,t • � r � � - P�i a:r`y �� .. �'.lr � ! W �e� S�n r r� �T•.��•'I <br /> � ,�'�i �l w�rke�v�ilh�the contrac�or;to�1�ermine th e�_Ocafion ior.the backw'ate��entioh�dewCe nd � �.,:` � <br /> unders�tan,d� tlia i� decisah e9a d n Tthe'l o�atwn�f t he d�I'ce'Wec�F i i���r t 5'4,; �"� , : ; <br /> � i � ���.c�1�`*' ��',�tiS2�4'F �s ��y,�' �.��f �^� r..r ^i�' .f.�.t�V{+1.'�� C� ��.�i�;�, i �7�```tbi. .I <br /> •�;Or My edt�iX�cvor ina�ded�e howit�,a�rcce�se�spect�Y�d mai�tain�e de��i(�� ,Y!y�£ f � ;�yl , <br /> :� � 9 understand thatil am�e�ponSible(o�maintaimng'the backweter p�evenHon deviceDand kee�g � � : :. i <br /> d in'gdctd Wo�king ord'er' un'less d i�mstalled in the cdy rlghl-oi way . '�: � r '�. ` <�,. ,� � <br /> . -' � � a .. ��. a ., . .. '-�' t � � ` : .. � � ti.`'t.f. . . <br /> �•Jf 1 sell my prope'rty I w�l�make¢ot8ntl�l�uyers aware o(the backwater p�eventlon�device 8nd.y= <br /> I Yhe need to`inspect and�aintamnt o�a regular basi� ; , '; ��; A�;�.;� f <br /> i � I am'enclosmg ail of 1he necessary paperwork(use the yellow Rebate�Submittal Checkllst) "�^F I <br /> . . - • � 4'" <br /> Selpct1from the following s • , ' � <br /> , � r ' , <br /> I ❑ The conlracto�_�dentified downspouts or other drainage Ilm�s that were conne��edtito my sew�j � <br /> , Iine.(between my house and ihe installed aewc�)�antl removed oY�erout8d them ., �,n_,y�<< < , , � <br /> ,,. r , t , .a'�r; ,rt. c S, , ,y�. � <br /> . e r i � '' �.a. ."r'�' '..'� . .n s i r� �u ' iy� {� rr�.r <br /> � � ❑ To my knowledg� my property has no d�Wnspouts or other dramage connetted to�my,µsewe ine��, - . � <br /> (between my house and fhe mstalletl device) ;' ` ''� ' ,� i ^�7,(�.�:�' ; t ' '� <br /> v � ` ' .Ar�'i/ �{� `.. 1 � � ,:] _ t � i�1 � �� �y)l 4. ..�1�'' �f � 4. <br /> '` Q 'There are down p uls orotheJ dr�inage Imes connecled to qiy sewep�,linye(b�hvge�,rpy hom,$,g� i��, ,: ' � <br /> and.the inslallc�tl dewee)SI underaland )hat loavmg these connec'hons creales e n`sk o�floodir�gy s ; i <br /> � and�I�accepl thal nsk yryLo-'-y,� • ' � '+ `� .�� ,rL�' `+��`F 'L� "'i�+ri` � <br /> .,"K� ry'Y "},�- S L* \ �� �� . :y ry .� r 4��.,�x y . <br /> v,'�-� �} )i''. � .ti"� 'i a '. �� N l� N} -' -�a -� . 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