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a+� v <br />P1iY...AR�iEEl1�N.T <br />ThE undersigned hereby requests the City of Everett to waive <br />ithe PRV charBe on his/her water service at <br />�/n���_��L� S,F_ f,V ;_?/�,lL_��. The undersigned <br />.— <br />represents that the sarvice at said location presently has a PRV <br />in eood working order and that, in consideration of Waiver of <br />said charQe, for the period that underslaned is a water service <br />customer at the above location, the undersigned agrees: <br />1. To maintain said PRV in Qood working order; and <br />2. T�� release the City of Everett from any and all <br />liability arising from increased operating pressures on <br />the �t5 transmission line to which the above water <br />service is connected; and <br />3. To indemnify and hold harmless the City oP Everett from <br />any and all claims related to the Yailure of the PRV <br />installed at the above location. This indemnity is on <br />behalP oP the undersigned, and the undersigned agrees <br />to notify the city of Everett oP any chanee of <br />ownership of the water service connection at tha above <br />location. <br />� • <br />DATEI? this a� �'aY of , 1987. <br />.sw�pa�'� �'���-Y� --- <br />STATE OF WASHINGTON) <br />� Issc <br />COUNTY OF��j�.W. <br />I certiPy that I know or have satisfactory evidence <br />that RR��JK V. SlC'oURA_SQ1J siened this <br />instrument and acknowledged it to be (his, her, their) free <br />and voluntary act for the uses and purposes mention in the <br />instrument. <br />(Seal or Stamp( <br />Dated : �t���-- <br />Signature of Q�n�.— <br />Notary Publi . _ <br />Title: <br />My commission xe pires: o2_L.1�_ <br />