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2. Business Information
4. First Name*
5. Last Name*
7. E-mail*
8. Phone Number*
10. Business Name*
12. Business Address*
13. Address 2
15. City*
16. State*
17. Zip*
19. Business Website
20. Doing Business in Lafayette Since *
22. Number of Employees *

    (full-time and part time)

26. Property Owner Information

    (if different than applicant)

28. First Name
29. Last Name
31. E-mail
32. Phone Number
36. Project Description
38. Project Description*
40. Total Estimated Project Costs *
41. Grant Amount Request*

    Maximum of 25% of project cost, not to exceed $5,000

43. Project Start Date*
    Project Start Date
44. Project End Date*
    Project End Date
48. Required Documentation
50. Proof of current lease or property ownership*
52. Project budget*

    Including two estimates/bids from contractors

54. Project narrative describing design or equipment components of your project*

    including but not limited to:

    1. Architectural renderings, site plans, conceptual designs, and/or renderings related to your project (if applicable).
    2. For a project including signage, an initial sign approval from the City of Lafayette Planning & Building Department (if applicable)
    3. Manufacturer’s description and/or specifications of new equipment (if applicable)
56. Business W-9*
57. Before Photo*

    Please submit at least one photo of the area to be improved. If you need to submit additional photos, you may email them directly to Alexander.Nelson@lafayetteco.gov. 

59. *

    1. Agree

    I attest that the information stated above is correct, that I have attached the required documentation, and that the project will be completed in compliance with all applicable City regulations.

61. Applicant Signature*
62. Date*
    Date
Leave This Blank:


64. 1. Receive an email copy of this form.
65. Email address

    This field is not part of the form submission.

66. Submit

* indicates a required field