Change Request
INSTRUCTIONS: Review the Declaration of Covenants, Rules and Restrictions for detailed information concerning permitted alterations. Completely fill out both sides of the form below and attach any photographs or drawings (if applicable) of the change requested. PLEASE ALLOW REQUIRED TIME FRAME FOR YOUR ASSOCIATION OR ARC REQUIREMENTS FROM RECEIPT OF YOUR REQUEST FOR REVIEW: The Architectural Review Committee will review your modification request. If the Committee has any questions regarding your request, they will contact you. CONTACT MANAGEMENT: Contact the Management Office (540-206-3721) if you have any questions regarding this process.

Owner's Community:*
Owner's Address:*
Owner's Name:*
Home Phone:*
Work Phone:
Type of Alteration:
Storm Door:

Description of Requested Change:*

ACKNOWLEDGEMENT OF HOMEOWNER: This will confirm that I/we have read the guidelines as they relate to this application and hereby agree to comply with said Covenants, Rules and Restrictions in the change/addition/improvement. I/we further confirm that I/we have read and will comply with all applicable rules and regulations established by the Association concerning the procedures to be followed in undertaking any change/addition/improvement. I/we further agree that I/we will be solely liable for any claims, including without limitation, claims for property damage or personal injury, which result from the requested change/addition/improvement. I/we acknowledge the responsibility for complying with all applicable governmental regulations, codes and ordinances; obtaining all necessary permits and inspections; and contacting Ms. Utility if digging; and indemnify the Association from and against any claim for failure to do so. I/we further acknowledge that I/we are responsible for all maintenance, repair and upkeep of any approved change/addition/improvement.
I agree to the above:*
Attachment (2MB limit):
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