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1 <br /> fi <br /> Backwater Prevention Device Rebate Program <br /> } <br /> Rebate Application Form <br /> `L <br /> Property Owner Name: 41, ��1^G�,G[.�T <br /> 1 <br /> Installation Address: l q3l PAdt 6 er <br /> City: <br /> Cve State: WA" Zip: ga41/ <br /> Mailing Address (if different); <br /> City: <br /> State; Zip: <br /> Email: 60}(/' 1141 a l G4vC4 ylrtact.(WYK Phone: (IP- 31(5-• 5-608 <br /> Total Cost to install Device (from contractor invoice): $ 'Y57 57 <br /> Please verify the following: <br /> Erl am the owner of the property where the backwater prevention device was installed. <br /> [eI worked with the contractor to determine the location for the backwater prevention device and <br /> understand that the decision regarding the location of the device was mine. <br /> My contractor instructed me how to access, inspect, and maintain the device. <br /> Mi understand that I am responsible for maintaining the backwater prevention device and keeping <br /> it in good working order, unless it is installed in the city right-of-way. <br /> IfIsellm <br /> my property, {will make potential buyers aware of the backwater prevention device and <br /> the need to inspect and maintain it on a regular basis. <br /> I am enclosing all of the necessary paperwork (use the yellow Rebate Submittal Checklist). <br /> 1 <br /> Select from the following: <br /> ❑ The contractor identified downspouts or other drainage 'lines that were connected to my sewer <br /> line (between my house and the installed device) and removed, or rerouted them. <br /> ❑ To my knowledge, my property has no downspouts or other drainage connected to my sewer line <br /> (between my house and the installed device). <br /> There are downspouts or other drainage lines connected to my sewer line(between my house <br /> and the installed device). I understand that leaving these connections creates a risk of flooding <br /> and I accept that risk. <br /> J F <br /> Signature <br /> Date � k <br /> { <br /> t.. <br />