1.

___________________________________

_________________________________

Name of Owner Requesting Approval

Phone Number

2.

_________________________________________________________________________

Address where Alteration will be made

3.

_________________________________________________________________________

Mailing Address of Owner, if different from above.

4.

Type of Alteration:

________________

Landscape

____________

Building Exterior

______________

Other

Please specify other:

_________________________________________________________________________

5.

Location of Alteration:

_____________

Front

_____________

Side

______________

Rear

_____________

Other

Please specify other:

_________________________________________________________________________

6.

Explain, in detail, what you are requesting permission to do, to include approximate dimensions:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

7.

Describe the type of materials to be installed:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

8.

Explain if any existing elements will be affected by this alteration:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________