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BACKWATER VALVE REQUEST FORM <br /> 0041111.".4 <br /> EY <br /> 1 <br /> Name <br /> Address /90 y (074-d t.t M1 f� i�'-mot £Lh - 9Q / <br /> Contact Phone #: "I�J ►30 -/y 7/ <br /> e-mail address Z6 S C 1 a (omcsf5t,LJ <br /> YES NO D� <br /> Experienced basement flooding? <br /> 9 ❑ <br /> cei,„ <br /> How many times? Ijrrr1164i <br /> L "0 <br /> Wks <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: everettpw@everettwa.gov <br />