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Download Expression of Interest Form - Mid and East Antrim Borough Council
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Carrickfergus Townscape Heritage Initiative EXPRESSION OF INTEREST FORM Building for which assistance is sought (PLEASE USE BLOCK LETTERS IF HANDWRITTEN) Address of property: ………………………………………………………………………………………………... ………………………………………………………………………………………………………………………………….. Postcode: ………………………………………………………………………………………………………………….. Is the building listed? Yes ⎕ / No ⎕ Is the building vacant? Yes ⎕ / No ⎕ If Yes - Grade A ⎕ B+ ⎕ B1 ⎕ B2 ⎕ Applicant details (PLEASE USE BLOCK LETTERS IF HANDWRITTEN) Name of Applicant: …………………………………………………………………………………………………… Contact Address: …………………………………………………………………………………………….……….. Postcode: …………………………………………………………………………………………………………………. Telephone no: ……………………………………… Mobile no: …………………………………………… E-mail: …………………………………………………………………………………………………………………….. Nature of applicant’s interest in the property? ( ) Freeholder ⎕ Leaseholder ⎕ If leaseholder length of lease? ………… years Expiry date of lease? ………. / …….… /…….… Please state nature of applicant (Please tick one box only) Company ⎕ Sole Trader ⎕ Partnership ⎕ Developer ⎕ Voluntary/Community Sector ⎕ Local Authority ⎕ Is any other organisational body currently being approached regarding financial assistance for the property? Yes ⎕ / No ⎕ ( ) If yes, please give details: ……………………………………………………………………………………….. ……………………………………………………………………………………………………………………………….. CARRICKFERGUS THI EXPRESSION OF INTEREST – V1 2016 1 Details of Proposal (PLEASE USE BLOCK LETTERS IF HANDWRITTEN) Please provide a brief description of the works you would like to undertake:* ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………… Are you aware that the THI scheme will require specific conditions to be met in terms of design, materials used and planning if grant offer is to be issued? Yes ⎕ / No ⎕ (Please ) Following completion of the works how will the building be used (Please ) ⎕ Commercial ⎕ Residential ⎕ Both Commercial & Residential ⎕ Other If Other Please Specify ………………………………………………………………………………….. Have you already employed an architect / architectural technician or other professional to prepare drawings and costings for proposed scheme? Yes ⎕ / No ⎕ Anticipated start date of the works? Month: …………………. Year: ……………….. * Please Note – that any work undertaken by applicant before written THI grant approval being received will be ineligible for grant support. Declaration I declare that to the best of my knowledge the information given in this form is correct Signature: …………………………………………………………… Date: ………………………………. PRINT NAME: …………………………………………………………………………………………………………… Please submit this form to the address below, along with any old photos of the building or drawings that have already been prepared for scheme to; Carrickfergus Townscape Heritage Office, Mid & East Antrim Borough Council, Museum & Civic Centre, 11 Antrim Street, Carrickfergus, BT38 7DG. Email – [email protected] Carrickfergus THI is administered by Mid and East Antrim Borough Council and co-financed by Council and the Heritage Lottery Fund CARRICKFERGUS THI EXPRESSION OF INTEREST – V1 2016 2
