Business Revitalization Program Application

I. Business Information

Business Name: *

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Have you been assisted under the Sign Program in the past? *

Yes

No

If yes, date: * +

Are you a: *

Business

Church

Non-Profit Organization

Civic Group

Number of employees: *

Are you the building/property owner? *

Yes

No

Have you been in the City for at least 1 year? *

Yes

No

Do you have a lease of at least 6 months? *

Yes

No

II. Sign Information

Business Signage (check one) *

No permanent business sign

Existing sign is dilapidated or weathered

III. Type of Sign: (check one)

Channel Letters *

Illuminated

Non-Illuminated

Cabinet: *

Illuminated

Non-illuminated

Pole: *

Yes

No

Emergency Grant: *

Yes

No

IV. Other types of assistance requesting: (Check all that apply)

Must obtain written permission from property owner

Check all that apply *

V. Applicant information:

First Name *

Last Name *

Business name: *

Street Address *

Address Line 2

City *

State *

Zip Code *

Business Phone *

Cell Phone *

Email Address *

VI. Property owner information:

First Name *

Last Name *

Business Name: *

Street Address *

Address Line 2

City *

State *

Zip Code *

Business Phone *

Cell Phone *

Email Address *

VII. OWNER/APPLICANT DECLARATIONS

The undersigned property owner hereby declares under penalty of perjury that he/she is the legal owner of the property. The undersigned also assumes responsibility for this application and agrees to enforce and abide by any conditions of approval in the implementation and exercise of the granted entitlement. *

clear

The undersigned applicant hereby declares under penalty of perjury that he/she is the tenant/lessee of the legal owner of the property described above and has the authority to make such application for approval. *

clear

Exterior paint	Seal coat on parking lot
New windows visible from street	Mural
Landscaping	Security Cameras
New exterior doors	Other aesthetic Improvement (list below) Other aesthetic Improvement (list below)