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POLK PLACE MODIFICATIONS REQUEST FORM

Call, email or print and mail the form below along with any plans to:

Polk Place care of Scott Alessi , CMCA scott.alessi@ghertner.com
Community Association Manager
Ghertner & Company
50 Vantage Way, Suite 100 Nashville, TN 37228
Contact: Design & Covenant Oversight Committee or Board of Directors

 Date: _______________________________   Section: __________________________ 

Owner(s): ______________________________________________________________ 

Address: _______________________________________________________________ 

Home Phone: _________________________   Work Phone: ______________________ 

FAX: __________________   E-Mail Address: _________________________________ 

Nature of Improvement: ____________________________________________________ 

________________________________________________________________________ 

________________________________________________________________________ 

As a prerequisite to consideration for approval, and prior to the commencement of the contemplated work, I have attached a complete set of building plans and specifications. 

If approved, I agree to build in accordance with this application and the attached plans and specifications. 

Signed: _________________________________________________________________ 

 

 FOR INTERNAL USE ONLY

 

APPROVED: ______________________    DISAPPROVED: _____________________ 

MORE INFO REQ’D: _____________________________________________________ 

BOARD OR COMMITTEE MEMBER APPROVAL/DISAPPROVALS: (NAME/DATE) 

 

 

 

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