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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: 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 PROJECT NAME: PARCEL INFO.: TOTAL LOT AREA: ZONING: SETBACKS – FRONT: SIDES: REAR: PROJECT DESCRIPTION: NEW DEMOLITION OTHER: SIGN HEIGHT ABOVE GRADE (FT): OCCUPANCY CLASSIFICATION: TYPE OF CONSTRUCTION: VALUATION AMOUNT: $ -OR- CONTRACT AMOUNT (PROVIDE COPY): $ PROJECT/UNIT TYPE: PERMANENT TEMPORARY SIGN TYPE: FREE-STANDING WALL DIRECTIONAL CONSTRUCTION OTHER: PERMIT / PROJECT INFORMATION PLANS ATTACHED NO PLANS PLANS ON FILE – CITY OF FERNLEY STANDARD 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: RCT: $ BUILDING PERMIT NO.: BP PLAN NO.: PERMIT FEE: $ PLAN REVIEW FEE: $ 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: PHONE NO.: CELL NO.: FAX NO.: ELECTRICAL 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 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 sign 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 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. I certify that I am licensed contractor pursuant to NRS 624. (Initial) Signature Date Print Name Title (architect, contractor, etc.) Project Address (address numbers and street name only) REVISED 2/2/05