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Name of Business: *

Project Address: *

Estimated Start Date: *

Estimated End Date: *

Brief Description of the Project: *

Upload Photos/Design of Project *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png tif pdf doc docx ppt xls xlsx mp3 zip.

Property Owner Name: *

Owner Address: *

E-mail:

Phone: *

Tax ID Number *

Business Owner Name, if Different Than Property Owner *

Business Owner Address: *

E-mail

Phone *

Business Tax ID Number: *

Funding Amount Requested: *

Project Location: *

Number of businesses in the building: *

Total Number of Employees: *

Design Firm/Architect, if needed:

How long have you owned the property? *

Name: *

Signature: *

Date

NAME: *

SIGNATURE:

New date *

PROJECT DESCRIPTION: *

Please read the statements and certify that you understand. *

I/We certify that the building owner is the owner of the property

I/We certify that there are no current code enforcement actions pending against this property

I/We have attached a copy of all current leases.

I/We certify that there are no outstanding property taxes, utilities, or other past due bills to the City of East Providence

I/We attached relevant photos of the building facade (s) to be included in this program.

I/We have reviewed the program overview and guidelines, have familiarity with responsibilities of each party and understand that the City shall not assume any liability for this or any such agreements.

I/We have read and understand the City of East Providence's Design Guidelines, accept the qualifications and conditions and through signature(s) below, certify that I/We are qualified and will abide by such conditions set forth in this application and all reasonable conditions which may be issued by the City of East Providence in the implementation of this program.

I/We understand that this is a voluntary program, under which the City of East Providence has the right to approve or deny any project or proposal or portions thereof.

Applicant Name: *

Applicant Signature: *

Date *

Applicant Name: *

Applicant Signature: *

Date *

Property Owner Name: *

Property Owner Signature: *

Date *

Property Owner Name: *

Property Owner Signature: *

Date *

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Store Improvement Program Application Form