Project Information	
Project/Development Name	     	
City in which the Project is Located	     	
Date	     	
Owner/Developer/Borrower	     	
Architect of Record	     	
General Contractor	     	
Request Prepared By	     	
Construction Type	 New Construction	 Substantial/Gut Rehab
 Adaptive Reuse	 Moderate Rehab	
	
Waiver Request Information	
Mandatory Criteria Number	     0.0x	
Mandatory Criteria Name	     	

1.	Indicate the issue:      

2.	Describe why the project is unable to achieve the criterion:      

3.	Provide actual cost differential if this mandatory criterion waiver request is based upon a cost hardship: