Laserfiche WebLink
Contractor Section: <br />/�r,�[,�v ��u. rMZ�NG (�3 -�:1� -�sS� <br />Vendor Name / Business Name / UBI Number <br />��G_G� �' G�1 > <br />State of Wasi��inaton Coniractor License Number: <br />.S `IG] 7/j r/Q i/i_ /1/i= M/�l i S�L' �5//3 7.�5. � iU _ <br />Vendor Mailing Address Gity Siaie Zip <br />�✓� � ����� � <br />Phone ' Email <br />I, the Vendor, agree to rzceive the Backiti�ater Prev2ntion Da�dce rebale cneck d!rectly for the <br />instalfation at the above referenced properiy adoress. By agreeine •o recalve lhe rabats check <br />directly, I agree to the follo�ving: <br />1. Tho Bac4water Prevantion Dewce r�bate amouN �eiil be deoucted irom ihe final invoic� <br />given to the propeity o�vner tor the installation at the property address rererznced above, ir <br />the toial cost or the installation is greatar tnan the rebate. <br />2. I, the Vendor, am a Washington State licensed contractor. <br />3. The Cit�� of Everett v�ill send a Federal Form 1D99 �iISC to me, lhe Vendor, for Backtvater <br />Prevenlion Device rebate paymenfs totaling more than S600 per calendar year, and will <br />report the same paymanis to the Internal Revenue Sen�ir.e. <br />i accept the payment of Cne Backwater Prevenlion Device rebate from lhe City ci Everett pending <br />approval of the completed Backivater Prevention �evice rebate packaye by the City o� Evereit <br />Signature of Contraclor <br />r� 9 �-1S <br />Date <br />