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P�iy..AG��N.T <br />The'underaianed hereby requests the City oP Everett to Waive <br />the PRV charge on his/her water service at <br />q/�l „��~1 Sf SE Sn�oMish U%n. 9d19�, The undersigned <br />represents that the service at �aid location presently has a PRV <br />in Qood workina orde� and that, in consideration of xaiver of <br />said charQe, Por the period that undersigned is a water service <br />customer at the above location, the undersigned agrees� <br />1. To mair,tain 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 transmisaion line to which the above water <br />service is connected; and <br />3. To indemnify and hold harmless the City of Everett from <br />any and ali claims related to the failure of the PRV <br />installed at the above location. This indemnity is on <br />behalP oE the undersigned, and the undersigned agrees <br />to notify the city of Everett of any chanqe of <br />ovmership oP the watar service connection at the above <br />location. <br />DATED this 1� day oP .Se �C�O1`� , 1987. <br />.__� W � <br />STATE OF WASHINGTON) <br />ss: <br />COUNTY OF Snelwinisl� � <br />I certiPy that I knoW or have satisfactory evidence <br />that ��.��N %�J._�OM F � signed this <br />instrument and acknowledged it to be (his, -he�.Sheir�- free <br />and voluntary act for the uses and purposes mention in the <br />instrument. <br />�� (Seal or Stamp( <br />Dated: <br />Siynatu <br />No*.,ary <br />Title: <br />My commission expires: � 1��_ <br />