BLD2022-0460_Other_4.12.2022_7.14.56_AM_2796106RESET FORM
Washington.
Energy Services _ �.
HOMEOWNERS ASSOCIATION (HOA)
HOME IMPROVEMENT AUTHORIZATION FORM
Larry and Anne Temple
04/09/2022
NAME OF HOMEOWNER DATE
206-363-2912 D la_temple@comcast.net
PHONE # UNIT # EMAIL ADDRESS
217 5th Ave. North Edmonds 98020
STREET ADDRESS CITY ZIP CODE
What type of home improvement work would be done? ✓ HVAC F Water Heater L_ Windows F Other
uc • ry Lcv ucwt.tctr i iyty yr wunn ntt4ut3.t tL):
Install Diakin multi zone ductless heat pump on deck with lines extending to livingroom and bedroom and electrical connection from
existing electric panel to heat pump location. Heat pump will be installed in pan. 15000 BTU unit to livingroom and 9000 BTU unit for
bedroom. Includes 1 year warranty and maintenance along with full equipment warranty.
Do you feel your neighbor(s) will be impacted by this change? I— YES D NO
HOMEOWNER ACKNOWLEDGEMENT
The homeowner acknowledges Washington Energy Services will not proceed with scheduling the requested work without HOA
approval.
04/09/2022
HOMEOWNER IGNATURE
DATE
•• AUTHORIZATION
The responsible HOA/Board Member authorizes the aforementioned work to be performed: i/ YES F NO
Larry R. Temple, Seville HOA Pres. ia_tempie@comcast.net
HOA/BOARD MEMBER NAME
EMAIL ADDRESS
04/09/2022
R SIGNATURE
DATE
Washington Energy Services I www.WashingtonEnergy.com 1 3909 196th St SW Lynnwood WA 98036 1 Ph: 800-398A4563 I License# WASHIES851NS