BLD2022-0459+HOA Letterr+4.12.2022_7.12.39_AM+2796104Washington :.
Energy Seances 4
HOMEOWNERS ASSOCIATION (HOA)
HOME IMPROVEMENT AUTHORIZATION FORM
William Notz 04/09/2022
NAME OF HOMEOWNER
206-294-2276
DATE
C notzwwl@gmail.com
PHONE # UNIT# EMAIL ADDRESS
217 5th Ave. North Edmonds
STREET ADDRESS
CITY
MOM
ZIP CODE:
What type of home improvement work would be done? W." HVAC 1- Water Heater I`" Windows F' Other
DETAILED DESCRIPTION OF WORN REQUE5TED: _
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? f- YES J7 NO
HOMEOWNER ACKNOWLEDGEMENT
The homeowner acknowledges Washington Energy Services will not proceed with scheduling the requested work without HOA
tipprovdl.
04/09/2022
HOMEOWNER SIGNATURE DATE
HOA AUTHORIZATION
The responsible HQAJBoard Member outhoriaes the aforementioned work to be performed: J7 yE5 F NO
Larry R. Templet' Seville HOA Pres. la-temple@comcast.net
HOA/BOARD MEMBER NAME EMAILADDRESS
HOA/BOARD MEMBER SIGNATURE DATE
Washington Energy Services I www.WashingtonEnergV.com 1 3909 196th St SW Lynnwood WA 98036 1 Ph: 800.-398-4663 1 LicenseP WASHIES851NS