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47,477. <br /> BACKWATER VALVE ACCEPTANCE FORM <br /> Thank you for participating in the City of Everett Backwater Valve Program. <br /> Date: _31nAv,e 4 , 291 L( <br /> Owner Name: V,rg-v„G CCIFA-Nro,� <br /> Backwater Valve Address: L2-3 t- c r 'k.,re_ <br /> The backwater valve installation is complete: <br /> Yes \E 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 El <br /> 11° , , <br /> / <br /> Signature j'_ Date 1 <br /> - <br /> S:\GMoen\Backwater Valve Program\Backwater Valve Acceptance Form.docx <br />