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_ <br />... .. P...�..._..�_..... . . . ..... ........_ <br />6 <br />The undersigned hereby requeats the City oP Everett to waive <br />the PRV charge on his/her Water service at <br />�a�,�� ����,��� dZ 0 , The underaiQned <br />r�r��� , <br />represents that the sarvice at said location presently has a PRV <br />in good working order and that, in consideration of waiver of <br />said charQe, Por tha period that. undersiQned is a water service <br />cusLomer at tha above location, the undersigned agrees: <br />1. To maintain said PRV in good working order; and <br />2. To release the City oP Everett from any and- all. <br />liability arising Yrom increased operating pressures on <br />the �5 transmission line to which the above water <br />service is co�nnected; 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 location. This indemnity is on <br />behalP oP the undersi8ned, and the undersiened agrees <br />to notify the city of Everett of any change of <br />ownership of the water service connection at the above <br />location. <br />DATED this��day oP , 1987. <br />��_ . <br />STATE OF WASHINGTON) <br />sa� <br />COUNTY OF �om:a�-) <br />I certify that I know or have satisfactory evidence <br />that ��,.� IZtulin2. ��.C_��' signed this <br />instrument and acknowledged it to be (his, her, eir) free <br />II and voluntary tict for the uses and purposes mention in the <br />! <br />, instrument. <br />natea : 4-3 � � ,_________ <br />(Seal or Stamp( Signature oP ���t_ (\ <br />Notary Public: slsR'��Q�r <br />Title: .�s�n ,Ci�^ <br />V <br />My commission expires: � 9�� — <br />, , _ _ .. <br />��n��e+�.�._...�.�-T.w-n��s.�T'w�T^f�e'.'�w'.�� !r^'i..�.�-��r^f.��w _ ' � • ..r f ♦ . <br />� .� . ��srrs� . . .. � . . <br />. .. _ ♦ . ' �. ' ' . <br />