Laserfiche WebLink
i � <br /> , <br /> ; <br /> i � <br /> ; �� <br /> � � <br /> �I �, <br /> Contractor Section: . ! I <br /> --- — -- —— ' I <br /> �M'R��- .�_"_��f 'it ;����r`-'' ; �"t�.3 � � I <br /> Vendor Name/ Eusine s IJame I UBI Number � <br /> I I <br /> ! <br /> AI�-, ` <• �-�-I--��. __- _ ' <br /> ; <br /> State of UVashinyton Contractor License Number. ; <br /> i <br /> �_W.�'.i[o L.r c11L'1_�p,,--��°t��'�-+l�c_�C'k�G� ' <br /> Vendor Mailing Address Cily State Zip i <br /> � „ (. c.�J'.�1�QL?��C�L2�L— f <br /> ��,_ ti�� g•x C�.,,�1� r i .F-_�?:�_� � <br /> , P},,,,,e _Email i <br /> j— � <br /> i <br /> I, the Vendor, agree to receive the Backvdater Prevenlion Oevice rebate check direcUy for the � <br /> installation al the above referenced property address. By agreeing to receive the rebaie check i <br /> directly, I agree to the following� <br /> 1. The Backwater Prevention Device rebate amount will be deducted from the final �nvoice i <br /> given to the property owner for the instailation at the property address referenced above, if l <br /> the lotal cost of the installation is gre�ter than the rebale. <br /> I <br /> 2. I, lhe Vendor, am a�Nashington State licensed contractor. � <br /> 3. 7he Cily of Everett will send a Federal Form 1099 MISC to me, the Vendor, for Backwater � <br /> Prevenlion Device rebate paymenis btaling more than �600 per calendar year, and will <br /> report lhe same payments to the Internal Revenue Service. i <br /> ----- -------- i <br /> — � <br /> I accept ihe payment of the Back�vater Prevention Device rebate from Yhe Cily of Everett pendin� � <br /> approval of the compieled f3ackwater Prevention Device rebale package by Ihe City of Everett ' <br /> i <br /> ! <br /> � �-�-(�-. i <br /> , ; <br /> � � <br /> ��1.�_���� -- � <br /> Sigrature of Contractor Dale � <br /> i <br /> — � <br /> --- ---- � <br /> � <br /> i <br /> i <br /> � <br /> ! <br /> I <br />