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� <br /> I <br /> � <br /> i <br /> I <br /> I <br /> � <br /> Contractor Section: i <br /> ! <br /> - - -- - 1 <br /> CJ'S PLUMBING&SERVICF LlC/602 950 117 ; <br /> Vendor Name/Business Name I UBI Number � <br /> CJSPLP59750D jI <br /> State of Washington Contractor License Number: i <br /> 552821BTH AVE NE GRANITE FALLS WA 90252 � <br /> _ <br /> Vendor Mailing Address City State Zip j <br /> i <br /> 360-691-5159 CJSPLUIdBINGna MSN.COM � <br /> � <br /> Phone - Email i <br /> 1 <br /> I, the Vendor, agree to receive the Backwater Prevention Device rebate check direclty for Ihe ` <br /> installation at the above referenced property address. By agreeing to receive the rebate check � <br /> directly, I agree to Ihe following: � <br /> I <br /> t. The �ackwater Prevention Device rebate amount�vill be deducled from the final invoice <br /> given to ihe property owner for the installation at the property address referenced above, i( 1 <br /> lhe total cost of the installalion is�reater than lhe rebale. J <br /> 2. I, the Vendor, am a VVashinglon Stale licensed conlraclor. � <br /> 3. The City of Fverett v�ill send a Federal Form 1099 MISC lo me, the Vendor, for Oackwater ' <br /> Prevention Device rebate payments totaling more than 5600 per calendar year, and will � <br /> report the same payments to the Internal Revenuz Service. • <br /> l <br /> - —- ---- - - ---- - --- — � <br /> I accr.pl Ihe payment o(the Rackwater Prevenlion Device rebale from the Cily o( [verett pending � <br /> approval of the completed Rackwaler Prevention Device rebate package by the City of Everett ! <br /> I <br /> I <br /> � <br /> � ' <br /> . � �� \ � � 1 I ! <br /> � <br /> Signature of Contractor �ate ! <br /> � � <br /> _ _-- - _ -- — -- - --- J � <br /> � <br /> I <br /> ' <br />