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Contractor 5ection: <br />/,a r,� LLc:y_}�G.�d.� ��1_cr'' (� 3— ciJ >- v SSf <br />Vendor Name I Business Name J UBI Number <br />1 <br />I �yrL41-'` S�C: � L1 ` <br />� Sfete of Udashin�ton Contraclor Licens� Number. <br />s�L7-7Jj ~�� n/;= ���.YS J���-,� W�J 5?K��t� <br />Vendor R92iling Address City Slete Zip <br />�"l �.5� ��sZ -'I�G�7 <br />Phone Email <br />I, ihe Vendor, agree ro receive the 8ecka�ater Pteventinn O�vi�e rebate check directiy ior ihe <br />maiailaeion at tho abcve refe; enced property addrass. By agr�eing to recei��a Ihe robate :heck <br />dhecl�y, I agree to the follotving: <br />1 The Back,vater Prevention Dev�ce re0ate amo�ni �vill be deducted irom th6 flnai invoir,� <br />aiven fo thc properly ov.r.er for tha instaliatioh at the property �tltlress tAterenc0d above, if <br />the total cost of the installa0on is greater then ihe rebate. <br />2, I, the Vendcr, sm a �dashtngton State Ilcsnseri cantractor. <br />3. 7he Clty af Everett will send a Fedetal Form 1Q�9 MISC lo me, the Vendor, for Back�vater <br />Pruveniion Devico mbato paymentc tofaling mora than 56D0 p=r calQndar year, ano Svill <br />�eport tha eame paymenis lo the Intemai Revenuo Senri�e. <br />I accept the oaymenf ai lhe Backwater Preventlon Oevice rebate irom thu City oi Ev�rett pending <br />approval of the Comploted Backt��ater Preventlon Devlce rebnte packeg� by the Clty ot Everett <br />� �.�-�^'� <br />� / <br />I� <br />Signatura of Coniractor �`"`�� .. <br />%���is'"` <br />Date <br />