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10200 263RD AVE SE LINE 5 WOODS CREEK WD 2016-01-01 MF Import
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LINE 5 WOODS CREEK WD
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10200 263RD AVE SE LINE 5 WOODS CREEK WD 2016-01-01 MF Import
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Last modified
6/12/2017 8:50:34 AM
Creation date
4/14/2017 11:16:36 PM
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Template:
Address Document
Street Name
263RD AVE SE
Street Number
10200
Tenant Name
LINE 5 WOODS CREEK WD
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PF!' AGREEMENT <br />The �andersigned hereby request� the City of Everett to waive <br />the PRV charp;e on his/her water servir_e at <br />WOODS CREEK WATER DlSTi:ICT 98230U The undersigned <br />�9-6-0-i-0-9�9-}s �–�fiazF-�:f--t�t�rrve;–�J��--93'?�P---' <br />represents that the servica at said location p��esently has a PRV <br />in good working order an�i that, iri consideration of waiver o: <br />said cherge, for the period that undersigned is a water servire <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 of Evorett from any and all <br />liability arisin8 Prom increased operating pressures on <br />the n5 transmission line to which the above water <br />servico is connected; and <br />3. To indennify �nd hold harmless the City of Everett from <br />any and all claims related to the failure of the PRV <br />installad at the above location. This indemnity is on <br />behalf oP the undersigned, and the undersigned agrees <br />to notify the city of Everett oP any change of <br />oxnership oP the water service connection at the above <br />location. <br />DATED this ��__ day oP ��/�� , 19Ei�. <br />WOODS CP':K WATER ISTRICT <br />STATE OF W.ISHIHGTON) <br />ss: <br />COUNTY OF S� �hi!% ) <br />I certiPy that I know or have satisfactory evidence <br />that __sL�C!//� `� /��'r/_�Nn—__----__ siened this <br />instrument and acknowledged it to be (his, her, their` fre�e <br />and voluntary act fcr the uses and purposes mention i.n the <br />instrument. <br />Dated: _ • <br />�� �� ------------- <br />(�aEl or St�mp( Signatu:c cY � �,��,�� <br />Notary Public: � _ <br />Y�='P.� <br />My commission expires: <br />l�. �y'r��� <br />
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