Facade Grant Form – City of Walhalla

Facade Grant Application

Address of Property(Required)

Applicant Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Owner Information (if different from applicant)

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Project Information

Scope of Proposed Project: Include a summary of the building's current condition, areas to be improved and how, as well as any proposed materials or colors. (Upload additional sheets if necessary)(Required)

Financial Information

Estimated Project Cost(Required)

Grant money applied for: $ (Maximum 50% of total cost - maximum $3,000)(Required)

Please enter a number from 0 to 3000.

Supporting Documents

Checklist(Required)

Budget/Cost Estimate

Letter of Consent from property owner

Drawings and/or sketch of project

Minimum of 2 color photographs of existing conditions

Paint and awning samples (if applicable)

City Permits applied for

IRS W9 Form

Application must be complete Budget summary/Cost estimate attached Letter of consent from property owner (if leasing) Architectural sketch of proposed project (if necessary) (Assistance available, if needed) A minimum of two (2) color photographs of building with existing conditions Paint and awning samples (if applicable)City permits applied for (if applicable) IRS Form W9 must be completed for the entity/individual receiving the grant.

File

Drop files here or

Max. file size: 32 MB, Max. files: 10.

Type Name to sign(Required)

Your typed name acts as your signature