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<br />New, Renovation, or Demolition <br /> <br />P & Z, 2-19-09 <br /> <br />Design Certificate <br /> <br />MAIN STREET DESIGN CERTIFICATE <br />ApPLICATION <br /> <br />Please return your completed application, along with required attachments, to the Main Street Development <br />office at 604 W. Fairmont Parkway. A Main Street Design Certificate is required before the Permit Division <br />is able to grant you a permit. <br /> <br />. Applicant Name Date <br />. Business Name <br />. Mailing Address <br />. Contact Phone Email Address <br />. Property/Building Owner Name Contact Phone <br />. Property/Building Owner Email Address <br />. Historical/Current Building Name <br />. Physical Building Address <br />. Type of Work: (check all that apply) <br /> _ Fa<;:ade Rehabilitation New Structure Demolition <br />. Details of Planned Improvements (attach additional paper ifnecessary): <br /> <br />. TOT AL ESTIMATED COST OF PROPOSED PROJECT: <br /> <br />Applicant's Signature <br /> <br />Date <br /> <br />Property/Building Owner Signature (if different from above) <br /> <br />Date <br /> <br />FOR CITY USE: <br /> <br />Recommendation <br /> <br />MS Design Assistant Review Team, Chairman Signature <br /> <br />Date <br /> <br />Recommendation <br /> <br />MS Design Assistant Review Team, Asst. Chairman Signature <br /> <br />Date <br /> <br />Recommendation <br /> <br />City Manager or Designee <br /> <br />Date <br /> <br />City of La Porte - Main Street Program <br /> <br />30f5 <br />