Name *

First Name

Last Name

Phone *

(###)

###

####

Do you have a survey of the home within the last 5 years? *

Yes

No

Unsure

Do you have an elevation certificate within the last 5 years? *

Yes

No

Unsure

Have you had soil borings done on the property? *

Yes

No

Unsure

Have you had a structural engineer inspect your home? *

Yes

No

Unsure

What is the exterior wall construction of your home? *

Masonry

Wood Frame

Unknown

Foundation type: *

Mono

Stem Wall w/ Slab

Stem Wall w/ Crawlspace

Unknown

Have you ever had your home re-piped? *

Yes

No

Are there large trees (18”+ diameter) within 10 feet of your home?

Yes

No

Is there at least 8 feet of clearance on all sides of your home?

Yes

No

Are you willing to wait for grant funding or do you want to move forward without it? *

Willing to wait on grant funding

Willing to move forward without grant funding

If using grant funding, the owner is typically responsible for 25% of the cost. *

Please select from the following options:

I have access to $60,000-$100,000.

I need contact info for loan options.

I am not utilizing grant funding.

Are you interested in possibly selling your home instead of lifting? *

Yes

No

If your home cannot be lifted, would you consider tearing it down and rebuilding? *

Yes

No