WASHINGTON PARISH GOVERNMENT PRELIMINARY APPLICATION - REQUEST FOR ELEVATION ASSISTANCE
This is only a preliminary application and does not constitute a guarantee that funding will be provided or that a grant will be approved.
Email address *
Home or structure location
Street address *
Your answer
City *
Your answer
Zip code *
Your answer
Owner information
First Name *
Your answer
Last Name *
Your answer
Spouses First Name
Your answer
Spouses Last Name
Your answer
Mailing address (if different from primary)
Your answer
City
Your answer
Zip Code
Your answer
Occupancy Type *
Building Type *
Construction Type *
Foundation Type *
Date Constructed *
Your answer
Building size (sq ft) *
Your answer
Value per sq ft($)
Your answer
Estimated Replacement Value($)
Your answer
Fair Market Value($)
Your answer
Estimated Date of 1st Flood *
MM
/
DD
/
YYYY
Depth Of Water In Inches *
Your answer
Duration Of Water In Structure *
Your answer
Percent Of Damage *
Your answer
Estimated Date of 2nd Flood
MM
/
DD
/
YYYY
Depth Of Water In Inches
Your answer
Duration Of Water In Structure
Your answer
Percent Of Damage
Your answer
Estimated Date of 3rd Flood
MM
/
DD
/
YYYY
Depth Of Water In Inches
Your answer
Duration Of Water In Structure
Your answer
Percent of Damage
Your answer
Do You Have An Elevation Certificate? *
Can you provide photos of all (4) sides of your house/structure? *
Do You Have Flood Insurance? *
Have you ever applied for Increased Cost of Compliance Through the NFIP *
I / WE UNDERSTAND that my application will be processed on a first-come, first-serve basis, depending upon funding available, the property owner match available, and the completeness of the application. I CERTIFY that all of the information that I have provided is true and correct to the best of my knowledge. I FULLY UNDERSTAND that if I provide any false or misleading information, my application will be disqualified. *
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service