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Z <br />?RV,_pGREE,MENT <br />RECEIVED <br />SEP 2� i�H/ <br />UTILITIES DIV. <br />The undersigned hereby requests the City of Everett to waive <br />the PRV <br />/OG�o� <br />charge on his/'.^�r water �ervice at <br />The undersigned <br />represenl:s that the service at said location presently has a PRV <br />in Qood workina order and that, in consideration of WAiver of <br />s;,id charge, for the period that undersigned is a Water service <br />customer at the above location, the undersienod agrees: <br />1. To maintain said PRV in good working order; and <br />2. To release the City of Everett from any and all <br />liabillty arising from increased operating pressures on <br />the #5 transmission line to xhich the above water <br />sarvice is connected; and <br />3. To indemnify and hold harmless the City of Everett from <br />any and all claims related to the failure of the PRV <br />installad at the above location. This indemnity is on <br />behalf of the undersigned, and the undersigned agrees <br />to notify the city of Everett of any change of <br />ownership of the water service connection ac the above <br />location. <br />DATED this �_ day of <br />STATE OF WASHINGTON) <br />ss: <br />COUNTY OF ��DM�SN � <br />I certify that I know or have satisfactory evidence <br />that __ =TZ�'_�*'^��'� siened this <br />instrument and acknowledged it to be (his, -l�+�rr��+e4��) free <br />and voluntary act for the uses and purposes mention in the <br />instrument. <br />(Seal or =`.amF� <br />�!�'��'J�5 ry � e!'�iC � <br />i1 5 ��,�5 F,i'a� •. : <br />; o �aGTARY9Fa: <br />.0 <br />, -.' * <br />• : • <br />�,�ql Gc �8 �,���,�,�or <br />'F of wAs��,�� <br />Dated: <br />Signature of <br />Notary Public: <br />Title� <br />My commission expires: � � <br />0 <br />� <br />