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New, Renovation, or Demolition DRAFT as approved by MSAB on 11-13-08 Design Certificate <br />MAIN STREET DESIGN CERTIFICATE <br />APPLICATION <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 />+ Applicant Name Date <br />* Business Name <br />* Mailing Address ry <br />* Contact Phone L email Address <br />+ Property/Building Owner Name .. .Corgi Ph6);f <br />* PrcpertylBuildi?�,a Owner 4nail Address <br />* Historical/pbroot Buildft Name <br />* Physical 1,,niAng Address <br />* Type of Work-- (ehecall that apply) <br />Fagade *dtPt#io;i S tu. volition <br />♦ Details of Planfied inkro*neo 6attach additio4ioer <br />p-, <br />��4 0 <br />7- 7� <br />♦ TOTAL ESTIMATED COST OF ftdYQSED PROJECT: <br />Applicant's Signature Date <br />Property/Building Owner Signature (if differentftom above) Date <br />FOR CITY USE: <br />--------------------------------------------------------------------------------------------------------------------------- <br />Recommendation <br />MS Design Assistant Review Team, Chairman Signature Date <br />Recommendation <br />MS Design Assistant Review Team, Asst Chairman Signature Date <br />City of La Porte - Main Street Program 3 of 4 <br />