To be filled out by Applicant and/or Builder  (To print open .doc or .pdf format)

*Property Owner’s Name: ___________________________________________________________

*Owner’s Address: __________________________________________________________________

*Home Phone: ______________ *Work Phone: _______________ Mobile Phone: _______________

*Email Address: _____________________________________________________________________

*Builder/Contractor Name: __________________________________________________________

*Builder’s Address: _________________________________________________________________

Home Phone: _______________ *Work Phone: ______________ Mobile Phone: _______________

*Email Address: ____________________________________________________________________

*Legal Lot Description: Unit: _____________ Block: ____________ Lot: _______________

Type of Construction: ______________________________________________________________

Amount of Fee Attached: $__________________ By Check Only

Comments: ______________________________________________________________________

Expiration of Permit: 9 MONTHS FROM DATE OF ISSUANCE

AGREEMENT: Owner/Builder
I/We have received and read a copy of the TVACC guidelines, agreement of covenants, conditions and
restrictions for construction, additions or modifications in Tahitian Village Units l-V, and agree as a condition of
the approval of this application to fully comply with all the conditions contained therein. I/We have not begun
any construction on-site. I/We will post a TVACC building construction permit prior to starting construction, to
be visible from the street.

*Owner’s Signature: _________________________________________ Date: __________________

*Builder’s Signature: _________________________________________ Date: __________________

For completion and use by TVACC

Date received by TVACC: __________________

Application submitted is: Approved __________ Not Approved: ____________ Date: ______________

_____________________________   __________________________   _________________________
Member, TVACC                    Date      Member, TVACC               Date   Member, TVACC            Date

_____________________________   __________________________
Member, TVACC                    Date      Member, TVACC             Date

Application No. __________________ Check No. ____________

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