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PRY..AaBEEl�t�' <br />RECEIVED <br />SEP 2 � 1�87 <br />UTILITIES DiV. <br />The underaiined hereby requests the City oP Everett to waive <br />tha PRV charBe on his/�wr water service at <br />L��� .3 � �„�r S� ���.�.�v !�(/.� 'r1P��lUTha undersianed, <br />representa that the sarvice at said location presently has a PRV <br />in Qood wnrkin6 order and that, in consideration cP Waiver of <br />seid charae, for the period that undersignad is a Water service <br />customer at the above location, the undersigned agrees: <br />�. To ma.lntain said PRV in good warking order; and <br />2. To release the City of Everett from any and all <br />liab111ty arlsing from inrreased operating pressurea an <br />the ft5 transmission line to which the above water <br />service is connected; and <br />3. To indemnify and hol.d harmless the Cit;� of Everett from <br />any and ali claims related to the failure of tha PRV <br />installed at the above location. This indemnity is on <br />behalf oY the under.signed, and tha undersiened agrees <br />to notiPy the city �P Everett oY any change of <br />owr►ership of the water service connection at the abova <br />location. <br />DATED this a�,W day of ��be!' , 1987. <br />� -- <br />STATfi OF WASHINGTON). <br />�u L_� ss: <br />COUNTY OF �1L�11�iiJ'f <br />I certiPy that I know or have satisfactory evidence <br />that ��b�+ �-• Sel��_ signed this <br />instrument and acknowledged it tc be (his, her, thair) free <br />and voluntary act for <br />instrument. <br />(Seal or Stamp( <br />the uses and purposes mention in the <br />Dated: �r�� a���� -- <br />Signature of <br />Notary Public� __ i'1U <br />Title: �4A y�1�� 4.� eli��eri�, _ <br />My commission expires: L�• /� l�L� <br />a <br />e <br />