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� <br /> � <br /> t <br /> ; <br /> ; <br /> i <br /> i <br /> i <br /> i <br /> Contractor Section: I <br /> , <br /> — _ — — i <br /> � <br /> CJ'S PLUMDING 8 3EHVICE LLC!G02 950 117 ' <br /> Vendor Name/ Business Name !UBI Number � <br /> � <br /> CJSPLPS9150D � <br /> State of Washington Contractor License Number: I <br /> 5528 216TH AVE NE GR�NITE FALIS WA 982�2 � <br /> Vendor Mailing Address Cily State 7_ip <br /> i <br /> 360•691-5159 CJSPLUMBING�Iv15tJ.COM � <br /> i <br /> Phone Email I. <br /> � <br /> - I <br /> I, the Vendor, agree to receive the Backwaler Prevention Device rebate check directly for the � <br /> installation at the above referenced property address. By agreeing to receive the rebate check i <br /> directly, I agree ro the following: <br /> f <br /> 1. 7he Backwater PreveMion Device rebate amount will be deducted trom the final invoice <br /> given to the property owner for the installation at the property address referenced above, if <br /> the total cost of the installalion is grealer than the rebale. , <br /> 2. I, the Vendor, am a Washington State licensed contraclor. � <br /> 3. The City of Everett will send a Federal Form 1099 MISC to me, the Vendor, for Backwater � <br /> Prevention Device rebate paymenls lotaling more Ihan $600 per calendar year, and will � <br /> r�port the same payrnenls to the Inlernal Revenue Service. � <br /> I 2ccept Ihe paymenl of the Eiackwater Prevention Device rebate (rom the City nf Everelt pending <br /> approval of ihe completed Backwater Prevention Device rebate packaye by the City of Fverett <br /> , G(,_ �Z-- � � <br /> 'ignaWre q onlrector Date <br /> l <br />