CarrickfergusTownscape 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 ⎕ If Yes - Grade A⎕ B+⎕ B1⎕ B2 ⎕

Is the building vacant? Yes ⎕ / No ⎕

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: ………………………………………………………………………………………..

………………………………………………………………………………………………………………………………..

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 –

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 / 1