1302 GRAND AVE 2016-01-01 MF Import

, i , ' ; ; Contractor Section: � i �— � �� I � ��r t-v i�l��l l� L�-.(., � L��'��j �"� ; Vendor Name/Busmess Name! UBI Number � `�?w'�r�= L G�I l,+ r,-,� , State of Washington Conlractor License Numbec ! � � � . .._ �� ,�� 1 C% `�� i �. � X .�-Ilj ��ri�iV�'�,�� l�(.'�'tL�' ; Vendor Mailing Address Ciry Siate Zip � ��, �' � 7�-7 S' . i ' C%�e ��.- �11;eC'Sewe�-��- i:=��dly,�om i Phone Email � i L_ � i I, ;he Vendor, agree to receive th� Backwater Prevention Device rebate check directly for the i installation at the above referenced pronerty add�ess. By agmeing to receive the rebate check � d�rectty, 1 agree to Ihe follov:ing. . ' 1. The Back�,vater Prevention Device rebate amount will be deducted Irom lhe final invoice given�o the property owner for the mstallation at the property address referenced above, if � !he (otal cost of Ine inslallation is greater than the rebale. 2 I, Ihe Vendor, am a Washington State licensed contraclor. 3 i he Ciry o(Everetl will send a Federei Form 1099 MISC to me, Ihe Vendor, for Dackwater ; Prevenlion Device rebate payments lotaling more than 5600 per calendar year, and will j report the same paymerds to the Internal Revenue Service. r _ ._ � _ � i i a�ept the paymenf of the Backwater Prevention Device rebale from Ihe Cily of Everett pending � approval of the compleled Backwatr.r Prevention Device rebale package by the City of Everett � � ' �l__� � � ' �'�� i .: / � ti, Signature of Cnntractor Dale i ' � � i i i i f i � _ . -.---- +�. ri; , . .. i ;�;• r -,i..ti "t1�i` +��:G�j � fu(�faTil f ` T:, t:uf�iVt a$„ �d f �lY'T" f3 , T �'. � aram � ti.��;� �! `7(:ir'fLSfl��f�v�r'a��:.i� _t,_._ rr� ! . .��,-.r _ , . � �-�------' - .. . _.. ..