Modification Request

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Request for Additions and/or Change in Approved Plans

Name:

 

Street:

 

City:

 

State:

 

Zip:

Phone:

 

Person or Agent to be contacted for additional information: _________________________________ 


Phone: ________________________________
I (we) propose to change or build the following:


___________________________________________________________________________

 

___________________________________________________________________________

 

______________________________________________________________________

 

We propose to commence construction on or about: ______________________________________


Or (date uncertain) _________________________________________________________________

The following documents are provided herewith in duplicate as required by the Graywood New Construction Committee:

__________________________ Plans


__________________________ Specifications


__________________________ Other


Please examine these preliminary documents and advise if they are approved or disapproved, or require additional information or plans.

 

Applicant: _________________________________ Date: _________________________

 

Approval Granted: _________________

 

Approval Denied Because: ______________________________________________________

 

___________________________________________________________________________

 

___________________________________________________________________________

 

___________________________________________________________________________

 

The Graywood New Construction Committee

 

By:________________________________________ Date:______________________________