Laserfiche WebLink
Contractor 5ection: <br />�i /�i,'-�i�i.v�1.�%�'��3�.�� �3 -�i � -�:SS� <br />Vendor Name ; 5usiness Name / UBI Number <br />� <br />� �'�r_`iLL f�'/_ S�C��,1.J <br />IState cf VJashington Coniractor Lic2nse �amber: <br />S`/D7 7/' �/�V1 /�Ji„ M/� jZ 3�S tJf:LL/'- Lt//) !S � 7�i <br />Ve^dor M2iiing Address City State Zio <br />i <br />� / � 5�.���-1.�U 7 <br />� Phone ' Email <br />I, lhe Vendor, 2�'P,? i0 fBCOi'J? Ifl? LiBCF:I'lSiB� t�fOV@lltion Device rebate ChBCk dll2Cll� i0i ih8 <br />��stallation at the abova reierenced preper,� addreas. By agree�ng to receive tne rabata check <br />;;irectly, I aaree io the folloriinp: <br />� The Bac<�:�ater Preven,ion Device rebate amouM �:�iil be deducted `rom tne final invo c2 <br />gi��an to ihe prope�ty a.vner tor lhe installation at the propery address rererenced above, if <br />Ihe total ccst o( �he irstallation is greai:r ;han the rebate. <br />2. I, the Verdor, am a�Nasnington State licensed contractor. <br />;. The City of Evere�t v�ill send a Federal Form i099 Iv11SC to me, iho Vendor, for 82ckwater <br />Prevention Device rebate payments totaling mo�e than So00 per catendar yea;, and �vill <br />r�ooR the same payments io the In;em�l Revenue Service. <br />�--- � <br />II accept the paymert of tho E3ackv, ater Prever�tion Device rebata `rom the City of Everett pendino <br />iapproval of the complefetl Back�;�ater Prevention Oevice rebate packaoe by ihe C�ry of Everett <br />Signalure of Contraclor ��_ Date <br />