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'HARBOUR RIDGE
YACHT&•COUNTRY CLUB'
12600 HarbourRidgeBouleQrd*Palm City,Fladda34990•(772).335-3000•(772)336-1469 E
REQUEST FOR REVIEWBY
HARBOUR RIDGE ARCHITECTURAL RE`'IEW BOARD
IFORM TO BE SUBMITTED BY APPLICA'_!T) I
N�hall tti ${t�1�'i'� � tY,
Name: Phone#:
Village: 1. tae o Address: j AMAMI
Date: ���
Description of Proposed Change: (Attach Sketch, Site Plan, County Required.Permits if applicable, plus
copy of the attached signed ApplicantfAR Agreement): .
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_(&M �cj-thf J-&OJeCh j, itartieV. RIAL of aWi oto f1bld 1AM6 5t 01th
Name of Contractor: Phone ft: 60`94\- 8"'M
Address of Contractor: (j
Permissiongiven to allow contractor access to home:
Yes C7 No 0 Signature of Applicant
i
HOA VILLAGE BOARD: Comments ConcernsQuestions for the ARB.
Signature of Village President: &k—a,- faj-1j Q a,.L .6
ARCHITECTURAL REVIEW BO ARD RESPONSE: Date received: ! 2
'I
Date Reviewed: 2_ 119 'Decision: Approved:--� Disapproved:
Comments:
Date returned to Applicant and Village President: +
fiftighdature of airrn
Tann �beT:70 10
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