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2. Owner Name:*
4. Street Address:*
6. City:*
7. State:*
8. Zip:*
10. Phone Number:*
11. Email:*
13. Address of Requested Abatement:*
15. Historic District:*

    1. Jewell
    2. Dougherty
    3. Lightburne

    1. Prospect Heights
    2. N/A

17. IF YOU ARE WITHIN A HISTORIC DISTRICT, PLEASE SEE PRESERVATION OFFICE (3RD FLOOR) TO DETERMINE HDRC APPROVAL REQUIREMENTS

19. DESCRIPTION OF IMPROVEMENTS
21. Exterior Improvements: Attach itemized bid(s) for work- be as specific as possible*
23. Exterior Improvements investment amount:*
25. Interior Improvements: Attach itemized bid(s) for work- be as specific as possible*
27. Interior Improvements investment amount:*
29. PROJECT REQUIREMENTS
31. Description of Project Timeline:*
33. Start of Construction:*
34. Estimated Completion:*
36. 50% Exterior*:*

    1. Yes
    2. No
38. *50% of actual construction cost (excludes architectural and engineering costs, fees, permits and financing costs)
40. Base Improvements Value (City to provide):
42. REQUIRED ATTACHMENTS:
    1. Itemized cost of improvements including listing by exterior and interior
    2. Current pictures of the site and existing structures
    3. Legal description of property
    4.  Most current real estate tax statement 
    5. Proof of property ownership
    6. Application Fee ($200)

44. IF WORK IN THE RIGHT OF WAY IS PROPOSED/REQUIRED (SIDEWALK AND DRIVE APPROACH) A RIGHT OF WAY PERMIT IS REQUIRED. PUBLIC WORKS DEPARTMENT APPROVAL IS REQUIRED. COPY OF PERMIT IS REQUIRED PRIOR TO STARTING WORK IN THE RIGHT OF WAY.

46. APPROVAL OF THE LMRC BOARD IS REQUIRED PRIOR TO START OF PROJECT.

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48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit Submit and Print

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