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8508 52ND ST SE LINE 5 2016-01-01 MF Import
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LINE 5
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8508 52ND ST SE LINE 5 2016-01-01 MF Import
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Last modified
9/15/2017 8:06:08 AM
Creation date
4/14/2017 3:29:09 PM
Metadata
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Template:
Address Document
Street Name
52ND ST SE
Street Number
8508
Tenant Name
LINE 5
Imported From Microfiche
Yes
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� <br />PR!�...AGB�EN�NT <br />Tha undersianed hereby requests the City of Everett to waive <br />the PRV charge on his/her water service at <br />s�� 5.��-0 .rr s�N .,_S'i1-oy�. The undersiBned <br />represents that the service at said loca'cion presently has a PAV <br />in �ood workin6 order and that, in consideration of waiver oi <br />said charge, for the period that undersigned 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 />2. To release the City oP Everett from any and all <br />liability arising from increased operating pressures on <br />the �5 transmisaion line to which the above water <br />service is connected; and <br />3. To indemnify and hold harmless the City of Ever•ett 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, and the undersiened aBrees <br />to notify the city of Everett of any change of <br />o�+nership of the watar service conneation at the above <br />location. <br />DATi.D this � day oP ��-�� , 1987. <br />STATE OF WASHINGTON) <br />,gs: <br />COUNTY O��t�3�- <br />I certiPy that I know or have satisPactory evidence <br />that _St-� �c � I/ER t9F� �C signed this <br />instrument and acknowledged it to be (his, her, their) free <br />and voluntary act for the uses a-►d purposes mention in the <br />inatrument. <br />natea: _9 - � �- � � ___— <br />�(Seal or Stampi Signature oP <br />� Notary Public� ���-- ��%�'�+� <br />Title: - - l� -�— �- <br />� My commission expires: _��_ • <br />
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