Architectural Change Request - NCW Version

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Owner Name:*
Property Address:*
Unit Number:*
Telephone Number:*
Email Address:*


CONTRACTOR AND JOB INFORMATION
Select Scope of Work:
Description of Work:
Contractor Company Name:*
Contractor Telephone Number:*
Contact Person For This Job:*
Contractor Email:


DOCUMENTATION REQUIRED (Total of all uploads may not exceed 2 Mb. A data compression program may be required for larger documents.)
Contract or Proposal for Work:*
Drawings or Plans:
Certificate of Liability Insurance naming the community (legal name required) as additionally insured:*
Certificate of Workers Compensation Insurance naming the community (legal name required) as additionally insured.:
Notice to Owner: A State of FL Notice of Election to Be Exempt Does NOT qualify as insurance and does not afford you or the community any protections.
Check here if you acknowledge that your contractor does not have Workers Compensation Insurance. An indemnity agreement will be required:


I (We), the applicant(s) herein, certify and represent as follows:

1. I (we) are the legal owner(s) of the above described unit.
2. The work, if approved, will be done promptly and properly by appropriately licensed contractors if necessary.
3. I (we) accept and acknowledge that the responsibility for maintenance and upkeep of the improvement/change shall solely be mine (ours), successors, assigns and subsequent property owners.
4. All work and the consequences thereof are solely at our risk and expense. We understand and hold Management, the Board of Directors and the Community harmless on account of any consequences resulting from this approval, if granted.
5. Certain changes may affect the site plan, final survey or Certificate of Occupancy at my (our) unit and the Consequences thereof are solely at my (our) risk.
6. No representation by the Management, the Association or the Board, either expressed or implied, is assumed hereby.
7. I understand that no work may commence until I receive a written notice of approval.

I have read and agree to all of the conditions listed above, and I agree to abide by the decisions of the architectural committee.:*


Name of Person Completing This Form:
Date:
I understand that this form is only to be used if my community does not have a website.:*
Architectural Request Form Processing Fee
@ $50.00 each
 

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