Laserfiche WebLink
Backwater Prevention Device <br /> Property Owner Rebate Form <br /> Backwater Prevention Device Rebate Form <br /> Print and return this form with your rebate package <br /> Property Owner Name: <br /> Property address: <br /> City: <br /> State: Zip: <br /> Mailing address (if different): <br /> City: State: Zip: <br /> Email address: Phone: <br /> Cost to install Backwater Prevention Device: $ <br /> Rebate Package Checklist <br /> Please check that you have completed and included the following items in your <br /> submission. Items indicated as[CONTRACTOR] will be provided to you by your <br /> contractor. <br /> [ 'the completed Backwater Prevention Device Rebate Form (this form) <br /> F] Map of the property with location of installed Backwater Prevention Device <br /> [CONTRACTOR] <br /> [P/A copy of the completed Backwater Prevention Device Final Installation Checklist <br /> [CONTRACTOR] <br /> The itemized invoice showing business name, address, license number and detailed <br /> costs of installation and materials. [CONTRACTOR]. Note: No rebate will exceed the <br /> total cost of the installation of the backwater prevention device work. <br /> A Vendor Payment Option Form signed by both the property owner and contractor IF <br /> you would like the City of Everett to pay the Contractor directly. Otherwise, the rebate <br /> check will be made Out and delivered to you. <br /> completed and signed Form W-9 (Request for Taxpayer Identification Number and <br /> tfei'-rification) <br /> Page I of 2 <br /> Revised 09/09/2014 <br />