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� BACKWATER VALVE REQUEST FORM <br /> Name Donavan Riege� _ _ <br /> Address ?�29 Rockefeller Ave, Everett 98201 <br /> Contact Phone �: 425 239 5633 <br /> e-ma�i add�ess donavan_rieger@hotmail.com <br /> YES NO <br /> Expericnced basement flooding7 ❑✓ � <br /> Ho�v many times7 tWICe __ <br /> Return this form to: <br /> Backwater Valve Request <br /> City of Everett Public Works <br /> 3200 Cedar Street <br /> Everett WA 98201 <br /> or <br /> email to: everettpwC�everettwa.gov <br />