Department of Permits and Inspections
4876 Hwy 1 ~ P.O. Box 425
Mathews, LA 70375
985-537-7603 ~ Fax: 985-532-2845
www.lafourchegov.org
revised 8/1/2017
Customer fill in highlighted sections:
PLEASE PRINT
Check one:
PERMIT #
PROJECT DESCRIPTION
______COMMERCIAL
______RESIDENTIAL
DATE:____________________
CENSUS
PROJECT COST
PHYSICAL ADDRESS ASSIGNED
CITY / STATE / ZIPCODE
SUBDIVISION
TRACT or LOT / BLOCK
PARCEL / ASSESSMENT NUMBER
ESN
SECTION
RANGE
COMMUNITY
TELEPHONE
TELEPHONE
TELEPHONE
TRAILER INFORMATION
TRAILER SIZE
FIRM PANEL
WIND SPEED:
YEAR MODEL
ELEV
PERMIT TECH:
ALT PHONE
EMAIL ADDRESS
LICENSE NUMBER
EMAIL ADDRESS
PROJECT INFORMATION
SERIAL NUMBER
ZONE
EMAIL ADDRESS
MAILING ADDRESS
CONTRACTOR & INFORMATION and/or
CITY / STATE / ZIPCODE
ALT PHONE
MAILING ADDRESS
APPLICANT & INFORMATION and/or
CITY / STATE / ZIPCODE
WARD
MAILING ADDRESS
OWNER of STRUCTURE & INFORMATION and/or
CITY / STATE / ZIPCODE
TOWNSHIP
ABFE
ELECTRIC COMPANY:
COLOR
EXTERIOR TYPE SQUARE FOOTAGE
ZONE
ELEV
REQ ELEV
GAS CO: If applicable
COMMENTS:
FEE $
This permit becomes null and void if work or construction authorized is not commenced within 180 calendar days from the date of issuance, or if construction or
work is suspended or abandoned for a period of 180 calendar days at any time after work is commenced. I hereby certify that I have read and examined this
application and know the same to be true and correct. All provisions of all laws and ordinances governing this type of work will be complied with whether
specified herein or not. The granting of this permit does not presume to give authority to violate or cancel the provisions of any other federal, state or local law
regulating construction or the performance of construction. I understand that all plan review and permit fees are non-refundable. By signing this application, the
applicant, owner or owner's agent gives Lafourche Parish Permit Department permission to enter the jobsite at any time during normal business hours.
Signature of Contractor or Authorized Agent
Date
Signature of Owner (If Owner/Builder on Residential)
Date
or
** Ordinance No.4285 regulates construction site pollution. All new construction must have a dumpster and portable toilet facilities on site.