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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.: ASSESSOR PARCEL NO. (APN): FLOOD ZONE: YES NO PROJECT ADDRESS: BUILDING OR SUITE NO.: CITY: FERNLEY STATE: NV ZIP CODE: 89408 SUBDIVISION: BLOCK: LOT NO.: PARCEL INFO.: TOTAL LOT AREA: ZONING: SETBACKS – FRONT: SIDES: REAR: / CORNER PARCEL: REAR NEXT TO ALLEY: PROJECT DESCRIPTION: TOTAL LINEAR FEET OF WALL/FENCE: RETAINING WALL WALL/FENCE COMBO: RETAINING WALL WITH WALL/FENCE ABOVE DEMOLITION OTHER: THE WALL/FENCE IS TOTALLY WITHIN THE BOUNDARIES OF THE PROPERTY LINE. THE WALL/FENCE IS LOCATED ON THE PROPERTY LINE. (SEE THE ATTACHED NOTARIZED AUTHORIZATION LETTER FROM THE ADJACENT PROPERTY OWNER.) WALL/FENCE HEIGHT ABOVE GRADE (FT): RETAINING WALL HEIGHT FROM BOTTOM OF FOOTING (FT): VALUATION AMOUNT: $ -OR- CONTRACT AMOUNT (PROVIDE COPY): $ PROJECT/UNIT TYPE: WOOD CONCRETE MASONRY PRE-CAST CHAIN-LINK OTHER: PERMIT / PROJECT INFORMATION: NEW PLANS ATTACHED NO PLANS PLANS ON FILE – CITY OF FERNLEY PLAN NO.: OWNER’S NAME: COMPANY: ADDRESS: BUILDING OR SUITE NO.: CITY: STATE: ZIP CODE: OWNER’S INFO.: PHONE NO.: CELL NO.: FAX NO.: FOR BUILDING DIVISION USE ONLY FILING DATE: BY: ISSUED BY: DATE: PERMIT FEE: $ BUILDING PERMIT NO.: BP PLAN NO.: PLAN REVIEW FEE: $ OWNER–BUILDER PERMIT PURSUANT TO NRS 278.573 ( RECEIVED ACKNOWLEDGEMENT FORM) OTHER FEE: $ ZONING REVIEWED BY: DATE: DEPOSIT RECEIVED: $ PLANS REVIEWED BY: STARTED: COMPLETED: TOTAL BALANCE DUE: $ Community Development Department 595 Silver Lace Blvd., Fernley, NV 89408 * [PHONE REDACTED] ---PAGE BREAK--- FOR BUILDING DIVISION USE ONLY BUILDING PERMIT NO.: BP 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.: BUILDING/GENERAL CONTRACTOR: CONTACT’S NAME: CITY OF FERNLEY BUSINESS LIC. NO.: NV CONTRACTOR LIC. NO.: CLASS: ADDRESS: BUILDING OR SUITE NO.: CITY: STATE: ZIP CODE: CONTRACTOR’S INFORMATION: PHONE NO.: CELL NO.: FAX NO.: I have indicated all natural and man-made watercourses that may have an impact on or be impacted by the proposed retaining wall, wall or fence. I understand and agree that should the City of Fernley determine that this retaining wall, wall or fence be detrimental to the safe flow of any watercourse, this permit will be rendered invalid immediately. I further agree that if I fail to adhere to the above requirements, the retaining wall, wall or fence may be abated, removed or altered at my expense. I understand and agree that the City of Fernley has no obligation to explain every requirement and ordinance to me prior to or during the course of this project. Furthermore, I understand that any and all City or State laws or ordinances are enforceable at any time, with or without prior notification. The issuance of a permit based on 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, or preventing building operations be carried on there under when in violation of City or State laws or ordinances. 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. It shall be the duty of the permit holder or their agent to notify the Building Official that permitted work is ready for an inspection. Requesting an inspection for work that is incomplete, in progress or not ready may result in a reinspection fee. It shall be the duty of the person requesting any inspections required by the code to provide access to and means for inspection of such work. Inspectors will not perform inspections in the presence of any unrestrained animals or in the presence of minors without a parent or legal guardian present. Work shall not be done beyond the point indicated in each successive inspection without first obtaining the approval of the Building Official. Any portion of work shall not be covered or concealed until authorized by the Building Official. The building permit, approved plans and inspection card shall be kept on the site of the work until the completion of the project. ---PAGE BREAK--- FOR BUILDING DIVISION USE ONLY BUILDING PERMIT NO.: BP I certify that I have read and understand this application and state that the above information is correct. I agree to comply with all City ordinances and State laws relating to building construction, and hereby authorize representatives of the City of Fernley to enter the above-mentioned property for inspection purposes. I certify that I have a legal right to apply for this wall/fence building permit and to authorize entry. Additionally, I certify that this application is in conformity with all conditions, covenants and restrictions, I have received all approvals required, and that all deed restrictions of record apply to and limit the use of this property. I certify that I am a licensed contractor pursuant to NRS 624. (Initial) I certify that I am an owner-builder pursuant to the provisions of NRS 278.573. (Initial) REVISED 2/2/05 Signature Date Print Name Title (architect, contractor, etc.) Project Address (address numbers and street name only) ---PAGE BREAK--- FOR BUILDING DIVISION USE ONLY BUILDING PERMIT NO.: BP I/We, owner of and (Print Name) (Address) I/We, owner of (Print Name) (Address) jointly agree to the construction of a retaining wall, fence and/or wall on the property line dividing our properties. Signature Date Signature Date State of ss. County of This instrument was acknowledged before me on this the day of , 20 , by Print Name of Signer Print Name of Signer Signature of Notary Public Community Development Department 595 Silver Lace Blvd., Fernley, NV 89408 * [PHONE REDACTED] }