Mayor Bill CarpenterCity of Brockton

Façade Improvement ProgramProperty Location:

Address: ______________________________________________________

Property Owner Information

Name: ______________________________________________________

Address: ______________________________________________________

Phone: ______________________________________________________

Email: ______________________________________________________

Website: ______________________________________________________

How long have you owned this property? __________ Copy of Deed: Attached

Number of businesses in building: _____ Types of businesses: ______________________

Total number of employees (of businesses): _____________________________________

General description of work to be completed:

_________________________________________________________________________

_________________________________________________________________________

Photographs of existing conditions (building and surrounding area) - attach on page 3

Estimate of design costs by contractor or architect, etc. $____________________________

Design firm, architect: ______________________________________________________

Address:____________________________________ Contact:_______________________

Estimated cost of façade improvement: $________________________________________

Estimated date of completion: ________________________________________________I understand that this is a preliminary application. Upon approval of the tentative application I will be asked for detailed information including financials, estimates of cost, details of improvements and schedules. I have read and reviewed the term sheet for the Façade Improvement Grant and understand the terms.

Applicant’s Signature: ______________________________ Date: _______________

Submit completed application to: Brockton Redevelopment Authority 50 School St. Brockton, MA 02301

Brockton Redevelopment Authority

Brockton 21ST Century Corporation

Application Deadlines April 1, 2017 and October 1, 2017

BROCKTON Storefront Façade Improvement Program

Existing Conditions

Property Address:

Latitude: Date: Longitude:

Photo OneStreet in front of building

facing North

Photo TwoFacing the building

straight on

Photo ThreeFacing the

building from left vantage point

Photo FourFacing the building

from the right vantage point