Third Places Fund Application

Be sure to fully review the Third Places Fund Grant Manual before beginning this application.

Step 1 of 7

Property information
Current Property Name:
Historic, common, or other property name:
(if applicable)
Property physical address:
Street Address City State ZIP Code
Date(s) of construction and major rehabilitations:
(approximate dates acceptable)
Is this property listed on the National Register of Historic Places?
Properties may be listed individually, or as a contributing building in a historic district.
- Yes
- No
Please upload a copy of the National Register nomination form.
Please upload a copy of the National Register nomination form.
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Max. file size: 50 MB.
Note: The property must be listed on the National Register of Historic Places by the conclusion of the grant project. If not yet listed on the National Register, grant applicants are required to demonstrate that the property is eligible for listing. Please upload a "determination of eligibility" letter from State Architectural Historian Michael Houser at the Department of Archaeology & Historic Preservation.
Note: The property must be listed on the National Register of Historic Places by the conclusion of the grant project.

If not yet listed on the National Register, grant applicants are required to demonstrate that the property is eligible for listing. Please upload a “determination of eligibility” letter from State Architectural Historian Michael Houser at the Department of Archaeology & Historic Preservation.
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Max. file size: 50 MB.
Application summary
Current use of property:
In one sentence, please provide a brief description of the current use of the property.
Proposed project summary:
In one sentence, please provide a brief description of the proposed grant project.
Grant amount request:
Note: The maximum request for this grant program is $75,000.

Property Owner Information
Name:
First Last
Email
Phone:
Mailing address:
Street Address City State ZIP Code
Confirmation of property ownership
Please upload proof of property ownership—this may be a page or screen capture from a county assessor’s website.
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Max. file size: 50 MB.
Is the property owner submitting this application?*
- Yes
- No
Applicant Information
Owner consent
Please provide documentation that you as the applicant have express permission from the property owner for this project, that you can demonstrate site control, and that the property owner is aware of and agrees to the program’s preservation easement requirements if a grant is awarded.
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Max. file size: 50 MB.
Name:
First Last
Email
Phone:
Mailing address:
Street Address City State ZIP Code

Description of Proposed Project
Please describe your proposed project in detail.
Please organize your detailed project description into specific phases or milestones and be sure to describe:
- • overarching project goals and measurable outcomes;
- • the techniques and materials to be used in the work;
- • who will perform what work (contractors, owner, volunteers); and
- • any community involvement (other funding support, volunteer support, etc).

Proposed project timeline:

Corresponding to how you organized your detailed project description above, please communicate your proposed timeline below by providing projected starting and completion dates for each proposed phase/milestone.

In the final column, please indicate whether funds are currently committed for each project phase/milestone. Commitment of funds means that you have cash on hand (or have an agreement with a lender) to complete project work before requesting grant reimbursement.

Proposed project phase or milestone (as described above):	Proposed starting date:	Proposed completion date:	Funds committed?

(Use the “plus” button to the right to add more lines for more project phases/milestones.)
If you indicated that funds are not yet committed for any of the above phases/milestones, please give a brief description of how you plan to get funds in place before your proposed project start date.
If you indicated that funds are not yet committed for any of the above phases/milestones, please give a brief description of how you plan to get funds in place before your proposed project start date.
Proposed project budget and bids:
Please upload the following:
- • Completed Third Places Fund – Budget and In-kind Details Worksheet
- • Three project estimates or bids from qualified contractors that support the information provided in your project budget.
- • Documentation demonstrating the qualifications and experience of your selected contractor(s) in working on historic structures.
- • Documentation of the estimated values of proposed in-kind labor, material, or equipment contributions to the project (if applicable).
- • Documentation of liability insurance for this project.
- • A professional property appraisal (only required for applications requesting grant funds to go toward property acquisition)
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Max. file size: 50 MB.
If you receive a grant, are you ready to immediately proceed with your project? If not, what needs to happen to be ready to proceed? Have you managed a project like this before?
Describe the urgency and importance of your project. What would happen if you did not receive this grant?

Confirmation and Submission
Accuracy of Information*
- I certify to the best of my knowledge that the information provided in this application is complete and accurate.
Accuracy of Information*
- I certify to the best of my knowledge that the information provided in this application is complete and accurate and that this application is submitted in full cooperation with the property owner.
Maintenance and Easement Agreement*
- As the property owner, I understand that if a grant is awarded, I will be required to enter into a maintenance and easement agreement on the property to ensure the building is not adversely impacted by future action, such as demolition or inappropriate alteration. I understand that the term of the easement will be 5-15 years, depending on the grant award. As the property owner, I understand I will not be reimbursed for any work completed until a recorded preservation easement is submitted.
Maintenance and Easement Agreement*
- As the applicant, I attest that the property owner understands that if a grant is awarded, the property owner will be required to enter into a maintenance and easement agreement on the property to ensure the building is not adversely impacted by future action, such as demolition or inappropriate alteration. The property owner understands that the term of the easement will be 5-15 years, depending on the grant award. As the applicant, I understand I will not be reimbursed for any work completed until a recorded preservation easement is submitted.
Federal Assurances Attachments
Please upload the following signed attachments:
- • Civil Rights Assurance (7A)
- • Statement of Understanding for Grant Management Requirements (7B)
- • Certification Regarding Disbarment (7C)
- • Form 424D (Construction Programs) (7D)
Drop files here or

Max. file size: 50 MB.

27355

Washington Trust for Historic Preservation

Third Places Fund Application

Step 1 of 7

Property information

Application summary

Property Owner Information

Applicant Information

Community Impact of the Third Place

Description of Proposed Project

Community Impact of the Proposed Project

Photos

Confirmation and Submission