Daytona Beach Riverhouse Inc.                       

715 S. Beach St.

Daytona Beach, FL 32114

386 -252- 4043 (Fax) 386 - 252 - 2698

1. Description of proposed modification to common area: ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Note: Common areas include any location or element which is not enclosed between the unfinished walls and floors and ceiling of your condominium. Your balcony/poarch, sliding glass door, windows, front door and screen door are included in the common area. Any modification to these elements must be submitted to the Architectural Review committee. This includes, but is not limited to, hurricane shutters.

2. Will you be modifying:

Front door: Yes [] No [] Sliding glass door: Yes [] No [] Screen/storm door: Yes [] No []

Kitchen windows:Yes [] No [] Bedroom windows: Yes [] No [] Balcony/poarch: Yes [] No []

Structural changes: Yes [] No []

3. Contractor Name: ____________________________________________________________

Address: ___________________________________________ Phone: ____________________

4. Condominium owners name: ___________________________________________________

Unit number: _________ Phone: __________________ Living on site: Yes [] No []

Signature of owner _____________________ Signature of owner _______________________

Date: ___ / ___/ ____

Please attach any photographs or supporting materials and submit this form to the Condominium Manager.

Date form received by Condominium Manager: ___________ Managers initials: ___________