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PRY ..A�B�EI"i�N.T <br />The undersiened hereby requests the City of Everett to waiva <br />the PRV charge on his/her water service at <br />�Q� 3 o S�5/.,:,_5,_;S/�/d.%���._---• The undersigned <br />represents that tha service at said location presently has a PFtV <br />in good working order and that, in co��sideration of waiver of <br />said charae, for the period that undersiQned is a water service <br />cust•omer at the above location, the undersigned aereas� <br />1. To maintain said PRV in good workinB order; and <br />Z liability arisingCfrom increasedtoperatingepressuresaon <br />the �5 transmission line to which the above water <br />service is connected; and <br />3 anyiandmnall claimsld elatedsto htheiPailureVofethe PRV <br />installed at the above location. This indemnity is on <br />behalf of the undersigned, and the undersiened aqrees <br />to notify the city of Everett oY any change of <br />ownership of tha -aater service connection at the above <br />location. <br />DATED this � daY �P�� � 1987. <br />..7F�"��`�" � . --- <br />STATE OF WASHINGTON) <br />c /� I� ss: <br />COUNTY OF O��l <br />I certi4y that I knovr or have satisfactory evidence <br />tnat _ F�aNX. V. S 1� ��$o /�1 signed tnis <br />instrument and acknowledged it to be (his, her, their) free <br />and voluntary act for tFie uses and purposes mention in the <br />instrument. <br />(Seal or Stamp( <br />Dated: � �-��-�— <br />Signature of <br />Notary Pub11 — ----- <br />Title: `Y�'���, • •'" <br />My commission expires� �=L�-- <br />