ARCHITECTURAL REVIEW COMMITTEE REQUEST FOR MODIFICATION

ARCHITECTURAL REVIEW COMMITTEE

REQUEST FOR MODIFICATION

MAGNOLIA TRACE AT CROSS CREEK PARCEL M ASSOCIATION, INC.
P.O BOX 342069, TAMPA, FL 33694-2069
Phone: 813-968-4709
Fax: 813-968-4728
Email: joannppm@verizon.net

I *

First

Last

, hereby request approval by the Architectural Review Committee for the modification shown below cUnit/Lot# *

Located at:

Address Line 1

City

State

Zip Code

Modification Request

Upon approval of my request for this modification, I/We will assume liability for any damage incurred as a result of this modification as well as any additional maintenance costs that may be incurred. I also agree to obtain any permits that may be required by any and all governmental agencies for this modification.

Attached, please find the following additional information:

A Sketch including the dimensions, of the proposed modification
The location of the modification on my property
Copy of the survey of my property
Color samples, if applicable.

Use additional sheets if necessary.

Telephone #

Owner E-Mail address: *

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Owners Signature *