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45-17 <br /> BACKWATER VALVE ACCEPTANCE FORM <br /> Thank you for participating in the City of Everett Backwater Valve Program. <br /> Date: 201 LI <br /> Owner Name: �a�c,-± e= ei 0 <br /> Backwater Valve Address: 21 \J,r cs v,-‘c. <br /> The backwater 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 functional: <br /> Yes ❑ No ❑ <br /> You were given instructions and training on how to maintain the backwater valve: <br /> Yes ❑ No ❑ <br /> You understand that you own the backwater valve and are responsible to maintain it in the <br /> future: <br /> Yes ❑ No ❑ <br /> r :20 pv, <br /> Signature OA l An„ iq loi'I ^ dal kLtj 040 1,( Date <br /> >n Ea urea lc ow. Q,� -ca� I- <br /> 4�►`li( `�y. �� ':SM1�Cctn. tiytly„ytG� CtLVN0Y154-ri \- o <br /> c7 unn Q-Ar ‘Na-"Cw t-d AM-Cl W0+ L;ae A+ +0 5 11." ► art flay tm g l lie <br /> f11St ta( t71 LytuPM 6(Vll wr4.5 � lfaLeG\ OwiG k kaitpr 1/it <br /> S:\GMoen\Backwater Valve Program\Backwater Valve Acceptance Form.docx f <br />