Required fields are marked with asterisks (*)

Historic preservation program intake form

Applicant information

Name

Address

Email address

Phone number

Address of the historic preservation site (if different from above)

Owner information

Please provide the property owner's information, if different from above.

Name

Address

Email address

Phone number

Program details

Which program are you applying for?

Historic Structure Assessment

Landmark

Historic Preservation Fund Grant

Historic Preservation Fund Loan

Alteration Certificate

Demolition Review

Are there any other details you'd like to share about the property?

Certifications

Please check each box to confirm your acknowledgement.

I understand that any grants provided by the City may be counted as income for tax purposes.

I am the owner of the property at the address above, or have been authorized by the owner to make an application.

I understand that only the property owner may be reimbursed for any and all grants.

Please type your full name to acknowledge these conditions.