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� <br />� <br />NI <br />?f {�eatS <br />��V ON <br />PRV.AaR�EM�NT <br />The undersiBned hereby requests the City o4 Everett to aaive <br />the PRV cherge on his/her Nater service at <br />�� � p��The un�eraiRned <br />6lad����—A"s.����-wr". -�A 1P <br />represents that• the service at said location presently has a PR� <br />in good workin6 order and that, in consideration oP Naiver of <br />said charge, for the period that undersigned is a water service <br />customer at the above loaation, the underaigned agreea: <br />To maintain said PRV in Bood working order; and <br />To release the City of Everett from anY and all <br />thebt�bittransmission�linecrto3eNhichTBtheg aboveurwate�r AS <br />service ia connected; and <br />To indemni4y 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 />tohenotify ttheuncityiBofa'EverettheoPndanYigchaneeYeof <br />owne�ship oP the wa*.er service connection et the above <br />location. <br />day o! , 1987 <br />D.4TED thie � � <br />�-- <br />���.2�j..a,� . 4:�►ti,P�vt� <br />STATE OF WASHINGTON) <br />COUNTY OF <br />/���gs. <br />I certify that I know or have satlsfactory evidence <br />that (tiuSJ�•�C1S--�AmaL�--��'�H� � �P� signed this <br />inatrument and acknoaledged it to be (his, her, their) free <br />and voluntary act for <br />inatrument. <br />(Seal or Stamp( <br />the uses and purposes mention in the <br />Dated: ��-s��-/l � �-- <br />Signature of � <br />Notary Public� <br />Title: <br />, �I My commissi <br />expires: <br />