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� <br />, <br />, <br />u <br />... . . _ _ ... - - <br />. ..,. - - - ------- -- -�.._...- --.. ._.. , . .. _.. _ ._.... <br />i <br />Contractor Sectlon: <br />� <br />�r� 7 �,_S 1 �_ <br />�VA or Name f 8uslneee Name 1 UBI Nun,bor <br />,Rs� // C'-��/�<��.� ��/ <br />lSjt� of Washington Contractor L�ense Number: <br />'��"S �� �'-�L �' , �fi _ <br />Vepdor Malling�Afidress City <br />�J �, c��X /3� /�u �/ <br />Phone � , �, F�mg�� <br />' � � `/!�:�, �/ <br />Steto Zip <br />� c2�r� 1/ <br />' � — T� ..� �'C� / ,�z/�c �"� c�l'�li>�,�'�, �eJc <br />7�. <br />I, the VeiWor, agree to recetvo the Backwater Preventlon Device robate check dlrectly for Ihe <br />installaUon et the ebave reterenced pmpMy addrtise. By aBreeing to recelve the rebale cheGc <br />directfy, 1 agree to the folfowing <br />1. The Beckwater Prevenlion Device rehate artnuM wlll be deducted Irom Ihe finel irtvoke <br />given fi the pmperty owner for fhe fnstaliallon at the propeAy addreas roferenced above, iF <br />the lolul cosl ot Ihe �nstallation Is grealer th� the rebate. <br />2. I, }F�s Vendor, am a Weehlrigron State ticnnwd contractor <br />3. The City af EvoreB wlll aend a Feder�l Foim 1099 MISC tu mn, Ibe Vendor, for Hackwaler <br />Pravenbon Devioe rebato paymenls tMs�ing mae thsn 5000 pe� calendar year, and wiB <br />— reporl lhe same paymenis fo the IrAarnel Rovenue SEwke--'— —�` _� <br />I accepl the paymant of (ho Backwutar Pieven� pevice rebale from the Cify of [verett pendmg <br />approv�l of Ihe compleled Baekwater PreronNon Devke rebate packago by Ihe Gty of fi�reretl <br />� 1 ~ / <br />���� ��� � � -�� J � <br />s�y�w� w cm����a o�o <br />; • • , .. <br />•, • <br />'. .', <br />.,. . . , <br />•.. �. <br />m <br />