Project Intake Form - City Of Depoe Bay

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DEPOE BAY URBAN RENEWAL AGENCY
PRESERVATION, REHABILITATION, DEVELOPMENT and REDEVELOPMENT INCENTIVE PROGRAM
PROJECT INTAKE FORM
Name of Applicant:
Date Submitted:
Street Address:
Telephone #:
Mailing Address (if different from Street Address):
Email:
Business Name:
Tax ID #:
Property Owner Name and Contact Information (if different than Applicant):
Project Property Site Address:
Lincoln County Assessor’s Map # and Tax Lot #:
Brief Description of Project/Use of Funds:
Will any new or additional off-street or off-site parking be provided as part of your project?
Y/N
If yes, how many and location:
Total Project Cost (see attached worksheet):
Amount of Grant Request:
Estimated Project Start Date:
Estimated Completion Date:
The statements made herein are true and represent an accurate and full disclosure of all appropriate information as of this date. Applicant
understands that the URA will retain this application and any other information the URA receives, whether or not this funding request is
approved. Applicant understands this request is public information; however any financial statements, tax returns, and business formation
documents will be kept confidential. Applicant agrees to enter into an Agreement with the URA and to work cooperatively with Government
officials on this project if funded.
Applicant Signature:
Date:
URA Grant Application Project Intake Form
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