Online Form - Local Heritage Fund Application Form

Local Heritage Fund Application Form

What is your full name? *

Please provide your ABN if applicable

Please enter the applicants address

Please advice the address of your heritage listed property

Are you the property owner?

YesNo

Please provide your email address

Please provide your best contactable phone number

Heritage Listing

City of Kalgoorlie-Boulder Local Government Heritage InventoryState Register of Heritage Places

Is there a conservation plan for this property?

YesNo

If yes, please advice when this was completed and who it was prepared by

Provide a description of the proposed works

Provide evidence that the works are in accordance with the conservation plan (if applicable)

Maximum size of ALL attachments is 976.56 MB

Please attach the following information

Maximum size of ALL attachments is 976.56 MB

Site Plan, Clear photographs indicating location and scope of proposed work, Photographs of the streetscape showing the place in relation to adjoining properties, Quotes for proposed work and any other additional supporting documentation.

Budget

Maximum size of ALL attachments is 976.56 MB

Please upload a project budget including the following: Cost of project, Applicant contribution, Amount from other sources, Amount requested from the City of Kalgoorlie-Boulder, Contributions by other funding sources (Lotterywest, Heritage Council of WA, etc).

Please attach two written quotes for proposed works

Maximum size of ALL attachments is 976.56 MB

How will your project contribute to the retention of the heritage listed place?

Acknowledgement *

I have read the City of Kalgoorlie-Boulder Local Heritage Fund Policy
I have read the City of Kalgoorlie-Boulder Local Heritage Fund Guidelines

Declaration

I declare the information provided is a true and accurate representation of the project.

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