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I PRV AGBEEMENT <br /> I <br /> I <br /> i <br />{ i The undersiQned hereby requests the City of Everett to waive <br /> � the PRV charQe on his/her water service at <br /> ���1 _^���____________. The undersigned <br /> ' represents that the service at said location presently has a PRV <br /> � <br /> • in Qood workine order and that, in consideration of waiver of <br /> � said charge, for the period that undersiened is a water service <br /> customer at the above location, the undersigned agrees: <br /> � 1. To maintain said PRV in good working order; and <br /> i 2. To release the City of Everett from any and all <br /> liability arising 4rom increased operatine pressures on <br /> � the �5 transmission line to which the above water <br /> iservice is connected; and <br /> � 3. To ind�mnify and hold harmless the City of Everett from i <br /> I any and all claims related to the failure of the PRV <br /> � installed at the above location. This indemnity is on I <br /> � behal! oY the undersigned, and the undersigned agrees i <br /> to notiPy the city of Everett of any change of , <br /> � ownership of the water service connection at the above <br /> � location. <br /> DATED this ,� 1 day of ����-� __ , 19 <br /> \ <br /> I • <br /> STATE OF WASHINGTON) <br /> ss: <br /> COUNTY OF �(r. ) <br /> � I certify that I know or have satisfactory evidence <br /> i , l //I <br /> ' that �� l l�_�1tt� 1yC11L��_- signed this <br /> I <br /> � instrument and acknowledged it to be (his, her, their) free <br /> ! and �oluntary act for the uses and purposes mention in the <br /> I <br /> j instrument. <br /> � <br /> � � � � '6 <br /> � Dated: _-,�—==�-�=�------- <br /> i � <br /> i (Seal or Stamp( Signature of - <br /> iNotary Public: 9 '��.-- <br /> iTitle: -------- <br /> i Mv commission expirea: y�`G�� <br /> I <br /> � <br />