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12527 THREE LAKES RD LINE 5 2016-01-01 MF Import
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THREE LAKES RD
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12527
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LINE 5
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12527 THREE LAKES RD LINE 5 2016-01-01 MF Import
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Last modified
4/21/2017 9:34:22 AM
Creation date
3/29/2017 10:37:23 AM
Metadata
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Template:
Address Document
Street Name
THREE LAKES RD
Street Number
12527
Tenant Name
LINE 5
Imported From Microfiche
Yes
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f . . <br /> ' ' I <br /> PR�_A�BF�MENT <br /> The underaigned hereby reQuests the City oY Everett to Waive <br /> � tha PRY charge on his/her aater service at <br /> I <br /> 2J z7 '3 �/}�IF'ES o p The undersi8ned <br /> -J---- <br /> ; represents that the aervice et said location presently has a PRV <br /> i in good working order and that, in consideration of waiver of <br /> ' seid charge, Por the period that underaigned is a water service <br /> cuatomer at the above location, the undersiened aerees: <br /> I <br /> i1 . To maintain said PRV in good working order; and <br /> 2. To release the City of Evorett from any and all <br /> I liability arisin6 from increased operating pressures on <br /> the �5 transmission line to Which the above water <br /> . � service is connectad; and <br /> I 3. To indemnify and hold harmless the City of Everett from <br /> any and all claims related to the failure of the PRV <br /> ' installed at the above location. This indemnity is on <br /> � behalf oP the undersigned, ai�d tiie undersigned agrees <br /> � to notiPy the city of Evere':t of any change of <br /> I ownerehip of the water servic � connection at the above <br /> ' location. <br /> � <br /> � DATED this ( h - day of S�f��'r , 1987. � <br /> i �G�LE�����4,�.�- <br /> STATfi OF WASHIN(#TON) <br /> ss: <br /> COUNTY OF-�'�"�'+"��A1' <br /> � I certiPy that I know or have satisfactory evidence <br /> � �yfl/�p��yy. _^_ signed this <br /> chat _�j�L�N�� � <br /> j instrument and acknowledBed it to be (his, her, their) Pree <br /> ! � and voluntary dct for the uses and purposes mention in the <br /> 1i instrument. <br /> IDated: ����9.8�"�P�.t1.��� ' <br /> I (Seal or Stamp( Signature of _____ <br /> Notary Public: <br /> I <br /> ; Title: __'�� - <br /> My commission expires� ��P� - <br />� <br />
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