Modification Request

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:______________________________