Façade & Interior Improvement Grant Program Application Date application submitted _____________________________________________________________ Applicant Name _________________________________________Tax Payer ID#_________________ c Building Owner c Tenant Property Address ___________________________________________________________________ _______________________________________________________________________ Phone number where you can be reached during the day ________________________________________ Email Address _____________________________________________________________________ Name of Property Owner, if different from applicant ___________________________________________ Property Owner Contact Information if different from applicant __________________________________ ________________________________________________________________________ ________________________________________________________________________ Type of improvement proposed: (you may check all that apply) c Exterior Façade c Sign c Site c Merchandising Assistance Grant c Tenant Improvement Grant c Other Please submit the following information in the order listed below by April 30, 2015, 3PM to the Main Street Preservation Trust office. Please provide 8 copies held with a binder a clip at the top left corner. Failure to submit in this manner may remove your application from consideration. c A. 8 ½ x 11 sheet of paper with typed name of business, address, contact name for project, phone number, and email in no less than 16 font. c B. Grant application with all information provided and signed c C. Written summary of proposed scope of work c D. Photographs clearly showing existing conditions of the building to be improved c E. Two cost estimates provided by an appropriately licensed contractor c F. Exact samples of paint, colors, materials, etc. that are being proposed with project c G. The property owner’s written approval, if owner is different from applicant c H. All required permits where applicable c I. If applicant is not the property owner, provide a lease valid for a minimum of one year c J. Paragraph explaining how the business supports the growth and sustainment of the Gloucester Village. c K.W9 Façade, Interior & Merchandising Grant Program www.gloucestervillage.com Façade Improvments Total Cost of Improvements ____________________________________________________________ Grant amount requested (50% of cost up to $20,000) __________________________________________ Source of matching funding ____________________________________________________________ Has funding been secured? ____________________________________________________________ Interior Improvments Total Cost of Improvements ___________________________________________________________ Grant amount requested (50% of cost up to $10,000) __________________________________________ Source of matching funding ____________________________________________________________ Has funding been secured? ___________________________________________________________ Merchandising Assistance Total Cost of Assistance _______________________________________________________________ Grant amount requested (50% of cost up to $2,500) ___________________________________________ Source of matching funding ____________________________________________________________ Has funding been secured? ____________________________________________________________ I understand that in order for my request for a façade and/or interior improvement grant to be approved, I must agree to work with the Design Committee and to follow the Gloucester Village Main Street Design Guidelines for Façade and Interior Grants. I understand that the Façade & Interior Program is a competitive award process and that submittal of this application does not guarantee funding. I also understand that monies are granted on a reimbursement basis following completion of work and approval by the Design Committee. I also understand that any changes made to the project after the grant approval, which have not be approved by the Design Review Committee, will not be eligible for funding and may disqualify the entire project for the grant funding. I also certify that if I am a tenant of the aforementioned property, that I have obtained authorization from the property owner to complete the project. I am a current member of the GMSA and understand that if awarded a grant of $5,000 or more, I am committing to a 3 yr. term of membership in the GMSA. I understand this amount is expected to be paid prior to receiving the grant payment. For membership fee info, please contact the GMSA at (804) 695-0700. Signature of Applicant __________________________________________________Project_________ Signature of OWNER if different from Applicant ______________________________________________ TO BE COMPLETED BY DESIGN COMMITTEE
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