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New, Renovation, or Demolition P & Z, 2-19-09 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 <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 />Fagade Rehabilitation _ New Structure _ Demolition <br />♦ Details of Planned Improvements (attach additional paper if necessary): <br />♦ TOTAL ESTIMATED COST OF PROPOSED PROJECT: <br />Applicant's Signature <br />Date <br />Property/Building Owner Signature (if different from above) <br />FOR CITY U <br />---------------SE: ----------------------------------------------------------------------------------------------------------- <br />Date <br />Recommendation <br />MS Design Assistant Review Team, Chairman Signature <br />Date <br />Recommendation <br />MS Design Assistant Review Team, Asst. Chairman Signature <br />Date <br />Recommendation <br />City Manager or Designee <br />Date <br />City of La Porte - Main Street Program 3 of 5 <br />