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, i. •� , <br /> IPRY A(3B�El1EHT <br /> The undersigned hereby requests the City oP Everett to waive <br /> � ths PRV charae on his/her water service at <br /> � ������ //1/Q(L �B�paar,�s/AO�dtS�. The undarsigned <br /> i <br /> j representa that the sarvice at said location presently has a PRV <br /> jin good work+.ne order and that, in conaideration oP waiver of <br /> � said eharQe, Por the period that underaignec�. ia a water service <br /> customer at the above location, the underaigned agrees: <br /> 1 . To maintain said PRV in good working order; and <br /> 2. To reler�se tbe City oP Everett trom any and all <br /> liabili•,:y ari:�'.ng Prom increased operating pressures on <br /> the tt5 trans�rission line to which the above water <br /> sarvice is coc:nected; an.+ <br /> 3. To indemnify and hold harmless the City of Everett from <br /> any and ail claims related to the Pailure of the PRV <br /> � installed at the above location. This indemnity is on <br /> � behalP of the undersigned, and the undersiened agrees <br /> to notiPy the city of Everett of any change of <br /> i oxnerahip of the Nater service connection at the above <br /> �ocation. <br /> i DATED this �_Q_ day o1 _ , 1987. <br /> � <br /> � <br /> 1�Q _ <br /> STATE OF WASHINGTON) <br /> ss: <br /> COUNTY OF����) <br /> I certify Lhat I knoa or have satisfactory evidence <br /> � that �1�q L_ �Ad-�-�1S.16�-�� ' ��-- gigned this <br /> Iinstrument and acknowledged it to be (his, her, their) Pree <br /> � and voluntary act for the uses and purposes mention in the <br /> jinstrument. <br /> i <br /> Dated: �I�Z_�— _____ <br /> / <br /> (Seal or Stamp( Signature oY <br /> Notary Public: _._____ <br /> I Title: — <br /> � My commission ��xpirea: ��Q__ <br /> � <br /> i <br /> I <br /> I <br />