1210 MAPLE ST 2016-01-01 MF Import

i ; ; i i � Contractor Section: i I -- I � CJ'S PLUIdBING 8 SERVICE LlC/602 950 117 Vendor Name/Business Name/UBI Number CJSPLPS9750D — I State of\ti'.�shington Coniractor License Numbec � i 552D 210TH AVE NE GAANITE FALLS WA 98252 _ � Vendor AAailing Address City State Zip 1 I ; 360�691•5159 CJSPLUMBING�MSN.COtit i Phone Email I, the Vendor, agree to receive the Backwater Prevention Device rebale check direclly for the mstallation al the above referenced properly address. By agreeing to receive the rebate check � directly, I agree to the following i 1. The Backwater Prevention Device renate amount will he deducted (rom Ihe final invoice j given to the property o�vner for ihe instailation at lhe property address referenced above, if � the tolal cost of ihe installatior,i;greater than ihe rehate � ! 2 I, the Vendor, am a Washino�on Slate licensed contractor. � 3 The Ciry of Everell will send a Federal Form 1099 MISC to me, the Vendor, for Backwater � Prevention Devlce rebate paymenls totaling more than ?600 per calendar year, and will i report lhe same payments lo the Internal Revenue Service. � ; — —_ t I accept Ihe paymenl of the Backwater Prevention Device rebate from the City of Everetl pending � approval of!he compleled Backwater Prevention Device rebate package by lhe City of Everelt � � � O�f�l'�� /S� Sign tur actor Date i -- -- - � I � I 1 � 4