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. ,. -.._ . . ._ ._ �_.__ . �_.- - - - . _ . -- - - <br /> . . � . � <br /> , <br /> . , <br /> . j <br /> , <br /> � I <br /> ' Contractor Sectfon: � <br /> � I <br /> � , <br /> ' ����� . ��S f, /� , <br /> I <br /> Vo or Name!Buslnese Neme/11Bl Nurnber ; <br /> � - - <br /> � ,��,�'�^._ ` � �J� J I <br /> ;� _�� �/Z�� �c.f1C�/ � ` , , <br /> �S�t,�' of Washington Contractar Lkense Number: ; <br /> : ���S �/: l' �- �/ �'.=� _, � � <br /> � i <br /> Vep{ior Mailinq�Idress Ciry Sca Zip � <br /> ; ' : �� G�, I�JU,� �_�L_ �JL l( ��Iy�� G'��i� `� �. �I <br /> � P one ! <br /> � Emaif� <br /> � � <br /> i ' - �7T�_:� �'��_��� ��.�>��n �� �`� <br /> � I, the Vendor, agree tn receive ihe Beckwater Preventbn Duvfce reDate cheCk dlreotly for Ute ��� � I <br /> � installallon at the ahove referenced propeAy addiese. By aAreeing to recelve'the rehate cheqk � I <br /> diroqly, 1 agree W the(ollowfng� <br /> i <br /> i <br /> 1 7hs Beckwater Prevention Oevfce rebale amourd wlll be deduCted Yrom Ihe Rnel Involoe i <br /> given ro the property owner for lhe Irretallatlon at tha property addreys relBre�ed abovQ if � <br /> the Ictal cosl o!the installalion is greater than fhe rebale. <br /> 2. I, Ihe Vendor, am a Wechington Stato lieonsed cor.fractor <br /> 3 The City ol Ever�will eend� Federai Form 10J0 MISC to me, Ihe Vendor, for Bact.wale� � <br /> ProvenGon Oc.wwo rebate payments lotating more than Y900 per plendar year,atxt wdl " I <br /> 4 roport tho seme paymenu ro the Irrierrtal lievenue Savfce. <br /> � ' <br /> - --- ------- - ,__ i <br /> (accapt the paymeM of the BacJcwater Prevention DEvice r�bate(ran the City of Everott pe�iding <br /> . approvaf of the catlpleted Baclaralet Prt,wenlion p+wlCe rebu(o pacicage by the Cfty of�veretl <br /> � - S_/ / 5`_ <br /> nature ot Cont actor Data . � <br /> , .' . � , <br /> ��. ' . • <br /> • '. � •,,' • - ; � ' . . <br />