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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 signedc C. Written summary of proposed scope of workc D. Photographs clearly showing existing conditions of the building to be improvedc E. Two cost estimates provided by an appropriately licensed contractorc F. Exact samples of paint, colors, materials, etc. that are being proposed with projectc G. The property owner’s written approval, if owner is different from applicantc H. All required permits where applicablec I. If applicant is not the property owner, provide a lease valid for a minimum of one yearc J. W9 Form c K. Thriving Main Street communities are dependent upon partnerships thru involvement and engagment by all businesses, property owners and residents. Please explain how you and your business plan to be a part of the Main Street Program for 2016 and what impact this grant will have on your business goals. Please do not exceed 500 words.

Façade, Interior & Merchandising

Grant Program

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 submit-tal 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.

Signature of Applicant __________________________________________________Project_________

Signature of OWNER if different from Applicant ______________________________________________

TO BE COMPLETED BY DESIGN COMMITTEE

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