Form Center

Applicant/Owner Information

Date*
Date
Name of Applicant*
**
Applicant Mailing Address*
Address2
City
State
Zip
Applicant Email:
Applicant Phone Number:*
Project Address*
Address2
City
State
Zip
If different from applicant, please provide property/building owner's name, address, phone number:
Provide detailed description of work to be done.
Include breakdowns by major categories, such as architectural, engineering, signs, awning, painting, repair, carpentry, electrical, etc. include detail of types of materials to be used and color specifications.
**
Continue

Proposed Improvements

Projected Cost

Project's Estimated Total Cost:*
Cost Breakdown
Work to Be Done
Estimated Cost
Attach Written Estimate
Work to Be Done
Estimated Cost
Attach Written Estimate
Work to Be Done
Estimated Cost
Attach Written Estimate
Work to Be Done
Estimated Cost
Attach Written Estimate
Work to Be Done
Estimated Cost
Attach Written Estiamte
Identify FIP amount requested and form of payment:
The facade program will provide up to $5,000 in matching grant and up to $10,000 in matching loan for a total of $15,000 for eligible Center City properties every seven years. Please select the amount of your facade request and whether it will be as a grant, loan or combination of both.
Amount Requested (50% of estimate)
Form of Payment
Amount Requested (50% of estimate)
Form of Payment
Amount Requested (50% of estimate)
Form of Payment
Amount Requested (50% of estimate)
Form of Payment
Amount Requested (50% of estimate)
Form of Payment
Continue |Go Back

Compliance Details

Has the project been reviewed by the City of Midland for building and zoning compliance?*
Attach Proof of Review (if applicable)
Are Applied-for Improvements:
Required as a result of any violation, notice or citation*
Non-permanent structures or movable equipemnt*
Required to comply with any code or ordinance*
Proposed project start date
Proposed project start date
Proposed project completion date
Proposed project completion date
Attach one photograph of the existing building.*
Attach a detailed color rendering of design plans including description of work and outlining the materials to be used along with other details of the project. *
The undersigned applicant affirms that:
- The information submitted herein is true and accurate to the best of my (our) knowledge.
- I (we) have read and understand the conditions of the CCA Facade Program and agree to its conditions and guidelines.
Signature of Applicant*
Date*
Date
Signature Confirmation*
1. By checking this box, I agree and confirm that the signature I have typed above is the electronic
representation of my original, handwritten signature when used on this document and creates a legally-binding statement. I further understand that signing this document using my electronic signature will have the same legally-binding effect as signing my signature using pen and paper.
Signature of property owner(s)
Upon review by the Center City Authority Director, prior to final approval and/or distribution of funds the signature of the property owner(s) will be required on a hard copy of this form.
Facade Dates - 2016

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
Submit | Go Back

Search Forms:

Center City Authority Facade

Steps

Applicant/Owner Information

Proposed Improvements

Projected Cost

Compliance Details