Please fill out the application below and return it, with proper signatures, to:

Village of Lombard
Attn: Community Development Department
255 E. Wilson
Lombard, IL 60148

Or Fax to: (630) 629-2374
Attn: Community Development Department

1. A. Building Address and Description:*

1. B. Property Identification Number:*

1. C. Legal Description of Property:*

2. A. Owner's Name:*

2. B. Owner's Address:*

2. C. Daytime Phone Number: ( )*

3. Current tenant, building address, lease terms and description of business (use additional sheet if necessary):*

4. Proposed improvements and renovations:*

5. Plans/drawings prepared by:

Name:*

Address:*

Daytime Phone Number:( )*

Estimated cost of the improvements and renovations:*

Statement of Understanding

The applicant (undersigned) agrees to comply with the guiedlines and procedures of the Downtown Improvement and Renovation Grant Program and the specific design recommendation of the Director of Community Development.

The applicant must submit detailed cost documentation, copies of building permits and all contractors' waivers of lien upon completion of work.

The applicant, owners and all contractors must comply with all federal and local regulations.

Business Owner Signature:________________________Date:__________

Property Owner Signature:________________________Date:__________