City of Philadelphia Redevelopment Authority

Please complete each section of form.

1. Contact Information

First Name

Last Name

Address

City

StateZip Code

Phone

Fax

Must provide active email address or
phone number for staff to contact you.

2. Property of Interest

Property Number One

Address

Cross Street

City

State Zip Code

Has any other city agency been contacted about project? (check one)

YES NO

If Yes, contact Person and Agency:

Phone

Has this agency pledged to provide public funding? (check one)

YES NO

If yes: What type of funding and how much?

Property Number Two

Address

Cross Street

City

State Zip Code

Has any other city agency been contacted about project? (check one)

YES NO

If Yes, contact Person and Agency:

Phone

Has this agency pledged to provide public funding? (check one)

YES NO

If yes: What type of funding and how much?

3. Property Re-Use Proposal

What is the type of redevelopment project you are proposing for the property? (check one)

Commercial

Retail

Manufacturing

Parking Lot

Residential

Single Family (check one)

Ownership

Rental

Multi Family (check one)

Ownership

Rental

Institutional

Educational Private

Health

Religious Establishment

Vacant Lot

Parking

Garden

Yard

Describe to the best of your knowledge, how you plan to redevelop this property. Please list the types of improvements or changes you are proposing.

Check all funding sources you will use for purchase of property and to rehab or construct on property:

Cash / Savings Accounts Loans Other

If loan or other, specify funding sources:

If property is available for purchase, you will be required to provide a check for an appraisal to be completed
to establish fair market sale price.

Digital Signature Date

1234 Market Street : 16th floor : Philadelphia, PA 19107 :: 215.854.6500