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i <br /> I <br /> � <br /> ; <br /> � <br /> I <br /> I <br /> Contractor Section: � <br /> I <br /> ---- -- I , <br /> CJ S PLUIdDING S SERVICE LLC�602 95D 177 I <br /> Vendor Name/Business Name/UBI Number � <br /> CJSPLPS9750D I <br /> Slate oi V��ashington Conlractor License Number: � I <br /> 5528 27ATH AVE NE GRANITE FALLS WA 98252 ` <br /> 1 <br /> Vendor Mailing Address City Stale Zip I � <br /> 360-691-5159 CJSPLUh1f31 NG�'u N�SN.COM I <br /> Phone Email i <br /> i <br /> - ; <br /> I, the Vandor, agree to receive the Dackwater Prevention Device rebate check direclly for the � <br /> insfallat�on at Ihe above reterenced property address. Dy agreeing to receive the rebate check � <br /> directly, I agree to ihe fotlowing ; <br /> 1 The Backwaler Preventien Dewce rebate amount will be deducted from the fina! invoice � <br /> given lo the property o�vner for the inslallahon at the property address referenced above, il <br /> I <br /> the tolal cost of the mstallalion is greater than the rzbate. � <br /> < <br /> 2. I, the Vendor, am a Washmgton Slate licensed coMractor ! <br /> 3. The Ciry of Everett will send a Federai Form 7099 MISC to me, the Vendor, for Backwaler � <br /> Prevention Device rebatc payments totaliny more than $600 per calendar year, and will � <br /> report lhe same paymenls tc Ihe Intemal Revenue Service. <br /> i <br /> --- ------ — -- � <br /> I accept the payment ot the �ackwater Prevent�on Dewce rebale Qom the City o(Everetl pentlin� � <br /> approval ol Ihe completed �ackwater Prrvention Device rebate package hy the Gry of Everett � <br /> � <br /> i <br /> '� r� �r,Z�-/� � <br /> I <br /> Signature of C clor Date i. <br /> i <br /> -- -- — � <br /> i <br /> � <br /> i <br /> i <br /> ' <br />