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�'ontracior Sec4ion: � � i <br />: . -.- .. ; <br />Vendor Name / Business Name / U61 Number <br />John Pestell 1 Side Sewer/ <br />Stale of Washington Conlractor License Number. <br />SIDES**853K8 <br />_� o� 7 <br />Vendor Mailing Address Cily St2te Zip <br />P.O. Box 137 Mukilteo, Wa 98275 <br />Phone Email <br />��s - %7� � �O17 � <br />' � `��f^'r'✓/ �..> / - <br />I, ihe Vendor, agree to receive Ihe Bacl;�vater Prevention evice rP,nate check directly for the � <br />inslallatian at Ihe above relerenced property address. By agreeing to receive ihe rehate checic <br />directly, I agree to the lolloc�ing� <br />1 <br />� <br />3. <br />� <br />The Backwaler Prevenlion Device rebate amount will be deducted tram the final invoice <br />given to the prapeAy owner tor 1he inslella6on al ffie proparty address re(erunced ahove, it <br />the total cost of the installalion is greater ihan ihe rebate. <br />I, the VenUor, am a Washington Slate licensed conlrac[or. <br />The City of Everett will send a Federal Form 1099 MISC lo me, the Vendor, ior Backwale� <br />Prevention Devicc reba[e payments lotaling more than $fi00 per calendar year, and will <br />reporl the same payments lo the Intemal Revenue Service. <br />I ar,cepl lhe payment oi the Bacicwater Prevenlion Oevice rebate irom the Ciry of Everett pe�ding <br />approval ot the wrnpleted Backwater Prevention Device rebate package by the CiD,� ot Everett <br />j� =Zz. /s <br />Date <br />