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PRY _AGI3�Eh1�NT <br />The undersiQned hereby requests the City of Everett to �aaive <br />the PRV charge on his/her water service at <br />L � <br />_P.Q_ ��Y /�2 S116IseIie�1' (, CIiQ� The undersigned <br />�' /oe�/� �Gr� ST S�. <br />represents that the service at said location pros:,ntly has a PRV <br />in Qood working order and that, in consideration of xaiver of <br />said charQe, Por the period +k�at undersigned is a water service <br />customer at the above location, the undersigned agrees: <br />1. To maintain said PRV in good workine order; and <br />2. To release the City of Everett from any and all <br />liability arising Prom increased operating pressures on <br />the �5 transmission 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 all claims related to the Pailure of the PRV <br />installed at the above lc�cation. This fndemnity is on <br />behalP of the undersigned, and the undersigned agrees <br />to notiPy the city of Everett of any change of <br />ownerahip of the water service connection at the above <br />location. <br />TIATED this �� day of <br />STATT OF WASHINGTON) <br />ss: <br />COUNTY OF /� ��i�m-s ) <br />I certiPy that I knoW or have satisfactory evidence <br />that C' e C���° �F�Jt i-��n signed this <br />instrument and acknowledged it to be (h���, heir) free <br />and voluntsry act for the uses and purposes mention in tha <br />instrument. <br />Dated: � �-/—� � --_______ <br />(Seal or Stamp( Signature of <br />Notary Public: ��i�' ri r�—� <br />Title: _�"�L�L --._ <br />My commission expires: I�—L���� �— <br />