PaintWorks Host Application

PaintWorks Host Application

Apply to host a PaintWorks mural! For full program rules, see the "Paper Form" link under the "For Property Owners" tab on the PaintWorks webpage: www.lsrcc.org/paintworks

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Proposed Project Site

Proposed project site must be within the boundaries of the Lincoln Square Neighborhood Improvement Program (SSA #21) and face the public way. Sites must have a surface area of at least 64 square feet.

Address Line 1 *

Address Line 2

City *

State *

Zip/Postal Code *

Applicant Name

First Name *

Last Name *

Applicant Address

Fill out ONLY if applicant address differs from the proposed project site.

Address Line 1

Address Line 2

City

State

Zip/Postal Code

Applicant E-Mail *

Applicant Phone Number *

Applicant is: *

Property owner Business owner Resident

Check all that apply

Property Owner Name

Fill out ONLY if applicant does not own the proposed project site.

First Name

Last Name

Property Owner Address

Fill out ONLY if applicant does not own the proposed project site.

Address Line 1

Address Line 2

City

State

Zip/Postal Code

Property Owner E-Mail
Fill out ONLY if applicant does not own the proposed project site.

Property Owner Phone Number
Fill out ONLY if applicant does not own the proposed project site.

Describe your desired site. *

Upload picture of desired site.

Describe why this project would be good for Lincoln Square. *

Statement of Understanding *

I have read and understand

I agree to fully comply with the guidelines and procedures of the Lincoln Square SSA PaintWorks Program and the provided specifications as agreed to by the applicant and SSA Commission. I agree that I have read the PaintWorks guidelines and agree to be fully bound by the terms and conditions therein. I RELEASE THE LINCOLN SQUARE SSA 21-2016 AND THE LINCOLN SQUARE RAVENSWOOD CHAMBER OF COMMERCE (TOGETHER WITH THEIR OFFICERS, DIRECTORS, AND AGENTS) FROM ALL CLAIMS AND CAUSES OF ACTION OF ANY KIND (KNOWN OR UNKNOWN) IN CONNECTION WITH THIS PUBLIC ART GRANT PROGRAM.

Statement of Ownership *

I certify that I am the owner of the Proposed Project Site. I am not the owner of the Proposed Project Site, but I certify I have obtained permission from the owner to pursue this application.
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