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Community Development Department 595 Silver Lace Blvd., Fernley, NV 89408 * [PHONE REDACTED] PLAN PERMIT APPLICATIONS, PLANS OR SUPPORTING DOCUMENTATION THAT ARE INCOMPLETE, ILLEGIBLE OR SUBMITTED IN PENCIL OR ERASABLE INK WILL NOT BE ACCEPTED. PLEASE PRINT CLEARLY USING PERMANENT BLUE OR BLACK INK. APPLICANT’S NAME: ROLE: OWNER CONTRACTOR OTHER: COMPANY: ADDRESS: BUILDING OR SUITE NO.: CITY: STATE: ZIP CODE: APPLICANT’S INFO.: PHONE NO.: CELL NO.: FAX NO.: REQUESTED NUMBER OF REPRODUCTIONS FOR FIELD USE (NOT TO EXCEED 10): 1 5 10 OTHER: SUBDIVISION/PROJECT NAME: PROJECT DESCRIPTION: NEW ADDITION REMODEL DEMOLITION OTHER: BUILDING HEIGHT ABOVE GRADE (FT): PROJECT/UNIT TYPE: DETACHED ONE- OR TWO-FAMILY DWELLING TOWNHOUSE ACCESSORY STRUCTURE: NO. OF STORIES: NO. OF UNITS: VALUATION AMOUNT: $ -OR- CONTRACT AMOUNT (PROVIDE COPY): $ FIRE SPRINKLER: YES NO ARE AREAS OVER 3600 SQ. FT., SEPARATED BY FIRE WALLS? YES NO NOT APPLICABLE FLOOR AREAS (SQ. FT.): LIVING SPACE: DECKS: PORCHES: BASEMENT/STORAGE: GARAGE: OTHER: TOTAL STRUCTURE AREA: UTILITY INFORMATION: CITY SEWER ( NEW EXISTING) CITY WATER ( NEW EXISTING) NATURAL GAS ( NEW EXISTING) LPG/PROPANE GAS ( NEW EXISTING) – TANK SIZE: – GALLONS ELECTRICAL SERVICE ( OVERHEAD UNDERGROUND) SEPTIC SYSTEM ( NEW – PROVIDE PERCOLATION TEST RESULTS AND SITE PLAN EXISTING – PROVIDE VERIFICATION AND SERVICE LETTER) SEPTIC TANK SIZE: – GALLONS ABSORPTION AREA – NO. OF DISTRIBUTION LINES: LENGTH OF DISTRIBUTION LINES (FT): PERMIT / PROJECT INFORMATION: WELL ( NEW – PROVIDE WELL DRILLER’S LOG AND LAB RESULTS EXISTING – PROVIDE WELL DRILLER’S LOG AND LAB RESULTS) ARCHITECT: ADDRESS: BUILDING OR SUITE NO.: CITY: STATE: ZIP CODE: PHONE NO.: CELL NO.: FAX NO.: ENGINEER OF RECORD: ADDRESS: BUILDING OR SUITE NO.: CITY: STATE: ZIP CODE: DESIGN PROFESSIONAL’S INFO.: PHONE NO.: CELL NO.: FAX NO.: FOR BUILDING DIVISION USE ONLY FILING DATE: BY: ISSUED BY: DATE: PLAN CHECK FEE: $ PLAN NO.: NO. OF FIELD COPIES REQUESTED: PRIVATE REVIEW FEE $ FIRE SPRINKLER SYSTEM REQUIRED BY YES NO (IF YES, APPROVAL MUST ACCOMPANY APPLICATION): OTHER FEE: $ ZONING REVIEWED BY: DATE: DEPOSIT RECEIVED: $ PLANS REVIEWED BY: STARTED: COMPLETED: TOTAL BALANCE DUE: $ ---PAGE BREAK--- FOR BUILDING DIVISION USE ONLY PLAN NO.: I understand and agree that the City of Fernley has no obligation to explain every requirement and ordinance prior to or during the course of this review. Furthermore, I understand that any and all City or State laws or ordinances are enforceable at any time, with or without prior notification. The approval of plans, specifications and other construction documents shall not prevent the Building Official from thereafter requiring the corrections of errors in said plans, specifications and other construction documents. The Building Official is authorized to suspend or revoke a permit issued under the provisions of the code wherever the permit is issued in error or on the basis of incorrect, inaccurate or incomplete information, or in violation of any ordinance or regulation of the provisions of the code. I certify that I have read and understand this application and state that the above information is correct. I certify that I have a legal right to apply for this plan review application. I understand that a plan review approval does not guarantee the issuance of a building permit. REVISED 2/2/05 Signature Date Print Name Title (architect, contractor, etc.)