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3. Applicant *
4. Applicant Address*
6. Applicant Phone*
7. Applicant Email*
9. Additional Applicant (if applicable)
10. Applicant Address
12. Applicant Phone
13. Applicant Email
15. Description of work to be performed for the conversion:*
17. Request for Taxpayer Identification Number (W-9)*
19. Be aware the City of Carbondale will require an inspection of the property to be converted prior to and after the conversion. The property must meet the building codes necessary to make the property a habitable space. Once the conversion is complete and all agreements have been signed (including the TIF Redevelopment Agreement), the City will issue all necessary grant funding.
21. Acknowledgment*

    By checking the "I agree" box below, you acknowledge that you have reviewed Ordinance No. 2016-30 and understand the terms and conditions and further allow the City to verify all the above information in order to ensure that the program requirements are met. Submission of this application does not in itself obligate the City or Home Owner without execution of the agreement.

    1. I agree.
23. Electronic Signature*
25. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
27. Electronic Signature*
29. Additional Applicant Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
31. Electronic Signature
33. Downtown Upper-Story Conversion Application Approved By:
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37. Submit

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