BLD2022-0459_Other_4.12.2022_7.12.39_AM_2796104NAME OF HOMEOWNER
206-294-2276
Washington
Energy Services'
DATE
PHONE # UNIT# EMAIL ADDRESS
217 5th Ave. North Edmonds 98020
STREET ADDRESS CITY
What type of home improvement work would be done? W." HVAC I- Water Heater I`" Windows F' Other
DETAILED DESCRIPTION OF WORN REQUESTED:
Install on deck lines i I
existing location. Heat pump will be 15000 BTU unit for
bedroom. year warranty and maintenance along with equipment
Do you feel your neighbor(s) will be impacted by this change? f- YE5 J7 NO
F HOMEOWNER ACKNOWLEDGEMENT
The homeowner acknowledges Washington Energy Services will not proceed with scheduling the requested work without HOA
approval.
HOMEOWNER SIGNATURE DATE
HOA AUTHORIZATION
OA/Board uthorizes
HOA/BOARD MEMBER NAME EMAILADDRESS