Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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