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SUBSIDY REQUEST APPLICATION

1 by Los Santos
Image

SPACER
DEPARTMENT OF PUBLIC WORKS
SUBSIDY REQUEST APPLICATION

SPACER
  • APPLICANT INFORMATION
    Applicant Name:
    Business/Company Name:
    Mailing Address:
    Phone Number:
    Construction permit: ACCESS

    SPACER
    SUBSIDY REQUEST INFORMATION
    SPACER
    Subsidy Amount Requested:
    Type of Subsidy Requested:
    • [ ] Infrastructure Development
      [ ] Environmental Protection
      [ ] Small Business Assistance
      [ ] Public Works Project
      [ ] Other: Specify
    Have you previously received subsidies or grants from the City of Los Santos?
    • [ ] Yes
      [ ] No
    If “Yes,” please provide the following information for each subsidy or grant received:

    Project Title:
    Amount Received: $##,###
    Completion Date:

    SPACER
    PROJECT DETAILS
    SPACER
    Economic or Community Benefits:
    • Describe how the project will benefit the City of Los Santos or the local community. Include any potential job creation, environmental improvements, or public service enhancements.
    Sustainability and Environmental Impact:
    • Explain how the project addresses sustainability and whether it includes environmentally friendly practices.
    Total Project Cost:
    SPACER
    DECLARATION AND SIGNATURE
    I, the undersigned, declare under penalty of perjury that the information contained in this application and accompanying documentation is accurate to the best of my knowledge. I understand that the issuance of this permit does not relieve me from complying with all local, state, and federal regulations governing the proposed construction project. I further understand that the City of Los Santos may revoke this permit if the project does not comply with the Public Works Construction Code or other applicable laws.

    Applicant signature:
    Date:

Re: SUBSIDY REQUEST APPLICATION

2 by Los Santos
Title:

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Subsidy Request - Project Title
Request form:

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[divbox=white][center][img]https://i.imgur.com/X01wJVo.png[/img]
[b][font=times new roman][size=125]
[color=#FFFFFF]SPACER[/color]
DEPARTMENT OF PUBLIC WORKS[/size]
[size=90]SUBSIDY REQUEST APPLICATION[/font][/b][/center][/size]
[color=#FFFFFF]SPACER[/color]
[list=none][color=#4c4c4c][font=times new roman][b]APPLICANT INFORMATION[/b][/font][line][/line]
Applicant Name: 
Business/Company Name: 
Mailing Address: 
Phone Number: 
Construction permit: [url=post_link_here]ACCESS[/url]

[color=#FFFFFF]SPACER[/color]
[color=#4c4c4c][font=times new roman][b]SUBSIDY REQUEST INFORMATION[/b][/font][line][/line]
[color=#FFFFFF]SPACER[/color]
Subsidy Amount Requested: 
Type of Subsidy Requested: 
[list=none]
[ ] Infrastructure Development
[ ] Environmental Protection
[ ] Small Business Assistance
[ ] Public Works Project
[ ] Other: [i]Specify[/i]
[/list]
Have you previously received subsidies or grants from the City of Los Santos?
[list=none]
[ ] Yes
[ ] No
[/list]
If “Yes,” please provide the following information for each subsidy or grant received:

Project Title: 
Amount Received: $##,###
Completion Date: 

[color=#FFFFFF]SPACER[/color]
[color=#4c4c4c][font=times new roman][b]PROJECT DETAILS[/b][/font][line][/line]
[color=#FFFFFF]SPACER[/color]
Economic or Community Benefits:
[list=none]
[i]Describe how the project will benefit the City of Los Santos or the local community. Include any potential job creation, environmental improvements, or public service enhancements.[/i]
[/list]
Sustainability and Environmental Impact:
[list=none]
[i]Explain how the project addresses sustainability and whether it includes environmentally friendly practices.[/i]
[/list]
Total Project Cost: 
[color=#FFFFFF]SPACER[/color]
[color=#4c4c4c][font=times new roman][b]DECLARATION AND SIGNATURE[/b][/font][line][/line]
[font=times new roman][size=85]I, the undersigned, declare under penalty of perjury that the information contained in this application and accompanying documentation is accurate to the best of my knowledge. I understand that the issuance of this permit does not relieve me from complying with all local, state, and federal regulations governing the proposed construction project. I further understand that the City of Los Santos may revoke this permit if the project does not comply with the Public Works Construction Code or other applicable laws.[/size][/font]

Applicant signature: 
Date:
Locked

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