Apply For Funding Funding: 100% up to $10,000 APPLICANT INFORMATIONList the names of the organization exactly as it is registered as well as the full names of all persons having an interest in the property. APPLICANT NAME(S):BUSINESS/ORGANIZATION NAME:MAILING ADDRESS Street Address Address Line 2 City State / Province / Region ZIP / Postal Code APPLICANT'S EMAIL: APPLICANT'S PHONE:IF THE APPLICANT IS NOT AN INDIVIDUAL, INDICATE THE TYPE OF ORGANIZATION: Partnership Corporation Limited Liability Corportation Other SS# or EIN#: IDENTIFY THE APPLICANT'S LEGAL INTEREST IN THE PROPERTY: Property owner having title Land contract vendee Purchaser by option or purchase agreement Lessee Other: PROJECT INFORMATION:PROPERTY ADDRESS: Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PARCEL NUMBER:CURRENT USE:PROPOSED USE (IF DIFFERENT FROM CURRENT USE):CURRENT AND/OR FUTURE TENANT(S):# OF FLOORS IN BUILDING:TOTAL LINEAR FRONTAGE AREA:PROJECT ARCHITECT NAME (IF APPLICABLE):PROJECT DESCRIPTION:TOTAL PROJECT COST:AMOUNT REQUESTED FOR REIMBURSEMENT:ESTIMATED COMPLETION DATE: MM slash DD slash YYYY INCLUDE THE FOLLOWING ATTACHMENT: Contractor estimates Site plans Photos of existing Conditions Lease (if applicable) Renderings Owner Approval Letter (if applicant is not the property owner) File Drop files here or Select files Max. file size: 128 MB. APPLICANT REQUEST:Applicant must read the following statement and sign. The undersigned hereby request that the Michigan Street Corridor Improvement Authority provide assistance to the project described in this application for the expressed purpose described above. The applicant affirms and acknowledges that the applicant has legal interest in the property as described on page of this application. The offer of assistance will only be effective upon execution of the agreement between the applicant and the Michigan Street CIA. The answers and statements contained in this application and in the attachments are in all respects true and correct to the best of my knowledge and belief.PRINT APPLICANT NAMEDATE MM slash DD slash YYYY SIGNATUREOWNER'S SIGNATURE:OWNER NAME(S):OWNER MAILING ADDRESS: Street Address Address Line 2 City State / Province / Region ZIP / Postal Code OWNER'S EMAIL: OWNER'S PHONE:If the applicant is not the owner or the property, the property owner must read the following and sign below. The undersigned hereby affirms and acknowledges that they are the owner(s) of the property described in the application, are aware of the contents of this application, and hereby authorize the applicant to submit this application and represent the undersigned in the matter being reviewed by the Southtown Façade Improvement Committee and CIA.PRINT OWNER NAMEDATE MM slash DD slash YYYY OWNER SIGNATURECAPTCHA
