Fillable CommercialRehabGrantApp2019Fillable City of Farmington

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CommercialRehabGrantApp2019Fillable City of Farmington

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Commercial Rehabilitation Grant Program
Grant Application
APPLICANT INFORMATION
NAME OF APPLICANT(S)
ADDRESS
CITY, STATE, ZIP
PHONE EMAIL ADDRESS
BUSINESS INFORMATION
LEGAL NAME OF BUSINESS
ADDRESS
CITY, STATE, ZIP
BUSINESS PHONE
FEDERAL TAX ID# DATE ESTABLISHED
SOLE PROPRIETORSHIP CORPORATION PARTNERSHIP
CONTRACT FOR DEED MORTGAGE PRINCIPAL
LESSEE TERMS OF LEASE
OWNERSHIP INTEREST OF ALL PARTIES NAMED ON TITLE:
NAME INTEREST
NAME INTEREST
NAME INTEREST
1
PROPERTY INFORMATION
ESTIMATED DATE OF ORIGINAL BUILDING CONSTRUCTION
ESTIMATED CURRENT TAX MARKET VALUE
NUMBER OF STORIES NUMBER OF BUSINESSES
NUMBER OF BUILDINGS NUMBER OF APARTMENTS
HAS THIS BUILDING BEEN HISTORICALLY REGISTERED?
PROJECT INFORMATION
BRIEF DESCRIPTION OF PROPOSED PROJECT:
ESTIMATED PROJECT COSTS
Improvements eligible for grant funding eliminate specific conditions detrimental to public
health and safety.
EXTERIOR/FAÇADE ESTIMATED COST
INTERIOR ESTIMATED COST
ELECTRICAL ESTIMATED COST
PLUMBING ESTIMATED COST
MECHANICAL ESTIMATED COST
FIRE SUPPRESSION ESTIMATED COST
TOTAL ESTIMATED COST
2
FUNDING INFORMATION
A 1:1 match is required by the applicant. For every dollar contributed to funding eligible
project costs by the Commercial Rehab grant program, the applicant must contribute one
dollar. The amount of grant to be awarded shall be $5,000 or greater, but not to exceed $35,000.
TOTAL GRANT AMOUNT REQUESTED $
APPLICANT FUNDS $
ADDITIONAL SOURCES OF FUNDING $
NAME OF FINANCIAL INSTITUTION
ADDRESS
CITY, STATE, ZIP
CONTACT PERSON PHONE #
I/We declare that the information provided on this application and the accompanying attachments is
true and complete to the best of my/our knowledge. I/We understand that any intentional
misstatements will be grounds for disqualification and that the City of Farmington has the right to
verify this information. I/We agree to provide the project coordinator reasonable access to information
and reasonable access to the construction project site so that they may monitor project
implementation.
APPLICANT(S)
DATE
DATE
DATE
3
MINNESOTA DATA PRACTICES ACT—TENNESSEN WARNING
In accordance with the State of Minnesota Government Data Practices Act, the City of
Farmington is required to inform you of your rights as they pertain to the confidential
information collected from you. Confidential data is that information which is not available to
you or the public. The personal information we collect about you is private.
The information collected from you and from other agencies or individuals is used to
determine the disposition of your application with the City.
The dissemination and use of the data collected is limited to that necessary for the
administration and management of the Commercial Rehabilitation Grant Program. Persons or
agencies with whom this information may be shared, include:
1. City of Farmington personnel administering the grant program.
2. The Dakota County Community Development Agency.
3. City Council Members, Economic Development Authority Members
4. Contracted private auditors.
5. Law enforcement personnel.
6. Those individuals or agencies to whom you give your express written
permission.
NOTICE PURSUANT TO MS.60A.955
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CommercialRehabGrantApp2019Fillable City of Farmington

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Completed 12 July 2020

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