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RECEIVED <br />PRV -AQPF ;19ENT <br />SEP 16 1&8/ <br />UTILITIES DIV. <br />The undersigned hereby requests the City of Everett to waive <br />it the PRV charge on his/her <br />5305 83rd Ave. S.E. Everett, Wa. 98205 <br />water service at <br />The undersigned <br />represents that the service at said location presently has a PRV <br />in good working order and that, in consideration of waiver of <br />said charge, for the period that undersigned is a water service <br />customer at the above location, the undersigned agrees: <br />1. To maintain said PRV in good working order; and <br />2. To release the City of Everett from any and all <br />liability arising from increased operating pressures on <br />i the a5 :.ransmission line to which the above water <br />iservice Is connected; and <br />3. To indemnify and hold harmless the City of Everett fron, <br />any and all claims related to the failure of the PRV <br />installed at the above location. This indemnity is on <br />behalf of the undersigned, and the undersigned agrees <br />to notify the city of Everett of any change of <br />ownership of the water service connection at the above <br />'ncation. <br />DATED this 14th day of —September // 1//987/./'� <br />�f6L", z/' f/�i�l��^ <br />STATE OF WASHINGTON) <br />ss: <br />COUNTY OF Snohomish ) <br />I certify that I know or have satisfactory evidence <br />that Helen E. Rera signed 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 />Dated: September 14, 1987 <br />(Seal or Stamp( Signature of <br />Notary Public: <br />Title: 14LS1Di1✓1r_8L11 fM1 <br />My commission expires: _9- L�_ <br />