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[Type here] Page 1 of 1 Rain Barrel Reimbursement Application Rev 07/2020 PUYALLUP’S RAIN GARDEN PROGRAM RAIN BARREL REIMBURSEMENT FORM Please complete this application and submit to Stormwater Engineering via email at: [EMAIL REDACTED] or via mail to: 333 S Meridian, Puyallup, WA 98371. I M P OR TA N T: I nt e rest ed appli cant s m u st first apply t o t he prog ram and be appr oved p ri or t o applyi ng for reim bu rsem ent fo r an eligible rain ba rrel p ur chase . P u rchases m ade pri or t o pr og ram appr oval a re not guarant eed f or p rog ram fundi ng o r reim b ursem e nt an d are subje ct t o pr og ram availab ilit y. PARTICIPANT INFORMATION Name: Street address: ZIP Code: Phone: Email: Parcel No.: RAIN BARREL INFORMATION What size barrel did you install: Where did you install the rain barrel: Required: Attach photograph of installed rain barrel PURCHASE INFORMATION Purchased from: Cost: Required: Attach copy of receipt. Reimbursement is limited to $125, not to exceed purchase price, including any applicable sales tax. Purchase Date: PARTICIPANT SIGNATURE Signature: Date: **TO BE COMPLETED BY PROGRAM STAFF** SITE INSPECTION Staff name: Date: Address of inspected rain barrel: Property within City of Puyallup limits: Yes No Barrel installed in appropriate location: Yes No Comments: Condition of existing GSI: Maintained In need of upkeep N/A Explain: REIMBURSEMENT DETERMINATION Reimbursement Approved: Yes No Explain: Approval Date: Reimbursement Notice and Restrictions: Installation of a rain barrel and submission of a reimbursement application does not guarantee reimbursement. Reimbursement is subject to Rain Garden Program Cost-Share Application Program Eligibility and Restrictions, program approval, and is the sole discretion of the City of Puyallup. Rain barrel purchase and installation must be confirmed by Program Staff. Purchases made prior to program approval are not guaranteed for reimbursement in the program.