Laserfiche WebLink
BACKWATER VALVE ACCEPTANCE FORM <br /> Thank you for participating in the City of Everett Backwater Valve Progrem. <br /> Date: �� ��/r T <br /> Owner Name: �-�a_�_�iL �� ���n - <br /> Backwater Valve Address: � � 0 �" I�(�Crl� '7I/-Q � <br /> The batkw Eer valve installation is complete: <br /> Yes � No ❑ <br /> You have been shown where the backwater valve is, and the flapper assembly is currently in <br /> place and fun tlonal: <br /> Yes � vo ❑ <br /> You were giv n instructions and training on how to maintain the backwater valve: <br /> Yes No ❑ <br /> You understand :hat you own the backwa[er valve and are responsibie to maintaln it in the <br /> future:.� � <br /> Yes li� No ❑ <br /> �Signature � � Date ��� � • <br /> S:�GMoen\Ba:kwaterVaNe Progam�BaUnaleNalvc h.u;U�:e Form.doc. <br />