Rustic Village Homeowners Association Section 2, Inc.

Architectural Modification Request

Owner(s): ______

Address: ______

Telephone (day): ______(evening) ______

Approval is hereby requested to make the following modifications, alterations, or additions as described below and/or on the attached pages. Included are such details as the dimensions, materials, color (samples must be attached), design, location, and any other pertinent data. Attached are copies of any available sketches, drawings or blueprints. Landscaping requests must include hand-drawn sketches and tree/plant names. (Please do not provide originals as all supporting documents are kept for our files.)

______Signature of owner Date

Architectural Committee Determination:

 Approved  Rejected ______Signature Print Name

 Approved  Rejected ______Signature Print Name

 Approved  Rejected ______Signature Print Name

Comments: ______

Instructions: Please mail request to: Rustic Estates 14748 SW 56 Street suite 228 Miami Florida 33183 For faster approval please email this form to: [email protected]