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Town of Pahrump Nye County Government Center 2100 E. Walt Williams Drive Suite 100 Pahrump, NV 89048 Phone (775) 727-5107 Fax (775) 727-0345 Town of Pahrump Business License Department Nye County Nye County Government Center 2100 E. Walt Williams Drive Suite 100 Pahrump, NV 89048 Phone (775) 751-7075 Fax (775) 751-7093 Pahrump Business License Packet Town of Pahrump ~ 2100 E. Walt Williams Dr., Suite 100, Pahrump, NV 89048 (775) 727-2815 Office Hours: Monday – Friday 8:00 a.m. – 5:00 p.m. (Closed 12:00 p.m. – 1:00 p.m. for lunch) Required Check List: Nevada State Business License (Provide Copy) REQUIRED Register with the Secretary of State online at www.nvsos.gov. Return the printed state business license with the Pahrump Business License application. For additional information or assistance, please contact Nevada Secretary of State (702) 486-2880. TAT varies based on license. Pahrump Regional Planning District Approval Letter (Online Portal) REQUIRED All applicants listing a Pahrump address must submit the online application by following the online submission directions included in this packet. Once approved, include a copy of your Approval Letter with your Pahrump Business License application. TAT 3-5 business days. Pahrump License Application (Complete) REQUIRED Complete the form and sign the form in the presence of a Business License Technician or provide a notarized signature. Notaries can include their own acknowledgement form. Affirmation of Compliance for Workers Compensation (Complete) REQUIRED This form must be completed even if you do not have employees. Complete the form and sign either declaration 1 or 2 at the bottom of the form. If Applicable Check List: Fictitious Firm Name Form (aka DBA) (Provide Filed Copy) If the name on your Nevada State License is the same as the business name on this application this form is NOT required. Submit the completed form, included in this packet, to Nye County Clerk's Office, 2100 E. Walt Williams Drive, Pahrump, NV 89048. Return the filed form with your Pahrump Business License application. Pahrump Valley Fire Form (additional fee applies) If your business is located in Pahrump, and your business will ever have customers/employees physically in the location. Complete the form and return it with your application. $50 fee will be applied to your license dues. The inspection will be done at a later date. Employer Identification Number (Provide Number or Copy) If you have employees, you will need to apply for an Employer Identification Number. You can apply by telephone at [PHONE REDACTED] or online at www.irs.gov. Enter the EIN on the license application. Nevada Sales Tax (Provide Copy) You can register with the Department of Taxation, at 555 East Washington Avenue, Ste 1300, Las Vegas, NV 89101 or online at www.tax.nv.gov. Return the printed registration confirmation with the license application. For additional information please contact [PHONE REDACTED]. Nye County is an Equal Opportunity Employer and Provider ---PAGE BREAK--- This page has been left blank intentionally. ---PAGE BREAK--- Pahrump Business License Packet Additional Information Specialized State or Board licenses (contractor, cosmetology, medical etc.) (Provide Copy) • If you will be providing food items, you will need to obtain a certificate from the Health Department. Please contact Sue Huff at 250 N. Highway 160 Ste. #101 Pahrump, NV 89060. She can also be reached at (775) 895-3604 or at [EMAIL REDACTED]. • Nevada State Contractors Board – (702) 486-1100 – 2310 Corporate Circle, Suite #200 Henderson, NV 89074. Please check their website at www.nscb.state.nv.us to see if your line of work requires you to have a Nevada State Contractors License. • If you will be having liquor or gaming at your establishment, you will need to obtain a Nye County Liquor/Gaming License. Applications are completed on the Nye County Website I Administration Department at or contact Samantha Tackett at the Nye County Administration Office, 2100 W. Walt Williams Dr., Ste #100 Pahrump, NV 89048. She can also be reached at (775) 751-4270 or at Pahrump Business License Fees and Payment Options: Fees are based on your Nevada State License Companies with a Pahrump address listed on the application: $100 Companies with more than 100 employees $75 Corporation or LLC $60 Partnership $50 Sole Proprietor Non-Local Applicants: $150 Companies without a Pahrump address listed on the application Local or Non-Local Businesses: $5 Chapter 82 or 501(c) Non-profit Corporations Exempt requires a Letter of Exemption from the Nevada Secretary of State on an annual basis Payment for fees can be made in person via cash, card (Visa, Mastercard, Discover, AMEX), or check payable to Town of Pahrump. If you are submitting a notarized application via email at [EMAIL REDACTED] a link for card payment will be emailed after processing, or you can mail a check payable to Town of Pahrump, 2100 E. Walt Williams Drive, Suite 100, Pahrump, NV 89048. Your Pahrump Business License could take up to 3-5 business days for processing from receipt of a complete application. If you have any additional questions, please feel free to contact me and I will be happy to assist you. Thank You, Marla McMahon – Town Administrative Coordinator Town of Pahrump (775) 727-2815 [EMAIL REDACTED] www.pahrumpnv.gov ---PAGE BREAK--- This page has been left blank intentionally. ---PAGE BREAK--- Online Business License Review Application with Nye County Planning Department Mandatory for All New Businesses Located in Pahrump & Address Changes Step 1) In a web browser, navigate to: Nye Count, NV I Planning Department I Business License Review Step 2) Click on the blue “Apply Online” button: Step 3) Select “Sign Up” on the application page – enter your email address and create a password. Then click the blue “Sign Up” button. Step 4) Follow the prompts to complete each page of the online application, clicking the blue “Next” button at the bottom of each page. ---PAGE BREAK--- Once completed, the online application will be received by the Nye County Planning Department for review. The Department may require additional information and will notify you of any pending items needed. This process can take up to 3-5 business days and the approval letter will be sent via email. Once received, the approval letter must be attached to your Pahrump Business License application. ---PAGE BREAK--- , Town of Pahrump 2100 E. Walt Williams Dr.#100 Pahrump, NV 89048 Phone ( 775) 727-5107 Fax (775) 727-0345 [EMAIL REDACTED] BUSINESS LICENSE APPLICATION For Official Use Only B/L# _ C/R#_ _ Start By _ Type of Business: Circle One C=Contractor H=Handyman R=Retail E= Exempt S=Service W=Wholesale N=Non-Profit Business Information Type of Ownership: Circle One S=Sole C=Corporation P=Partnership L=Limited Liability Co Business Name Corporation Business Contact Person Physical Address City State Zip _ Mailing ____Zip _ E-mail _ Fax Business Description: Will any customers/clients or employees ever be present at your business location? Yes No Special License/Registration Requirements: (Example: Nevada State Contractors License) Please include a copy or copies of Special Licenses # Employees _ Agency: Lis # Exp _ Authorized Representative: Circle one-OWNER---OFFICER---MEMBER/MANAGER---PARTNER Name Address _ City State Zip _ SSN ID Please read and initial each statement below 1. I understand that obtaining this Business License will not in itself exempt me, or my business from satisfying the requirements of the Pahrump Zoning and Conditional Use Permit Ordinance. Initial 2. I have satisfied all the Nevada Revised Statutes, and obtained all the required permits and licenses for this type of business. Pending:__ Initial 3. I have never been refused a business license or had a business license suspended or revoked in Nevada or in any other state. Initial 4. I do not owe any license fees or penalties for any other business licenses issued to me. 5. I understand a Code Enforcement Officer or Licensing Officer may issue warnings, citations, cease and desist orders, and/or may assess penalties for non-compliance with Pahrump Town Ordinance #35. (Business License Ordinance) Initial I solemnly swear or affirm that statements in this application are true and correct. It is my responsibility to determine and comply with appropriate Federal, State, County and Town requirements. Misrepresenting or failing to reveal requested information may be cause to refuse or revoke my business license. I will comply with the business license ordinance and amendments adopted or enacted by the Town of Pahrump. My license is issued specifically to me and my business only. I will not transfer this license to any other person or business. Subscribed and sworn before me on this Signature of Authorized Representative/Applicant of of Notary Public or Business License Employee State of Nevada County of Nye BLfonnAPP2(}(Up1(rev2006.05.1U) 3 ---PAGE BREAK--- This page has been left blank intentionally. ---PAGE BREAK--- STATE OF NEVADA, DIVISION OF INDUSTRIAL RELATIONS AFFIRMATION OF COMPLIANCE WITH MANDATORY INDUSTRIAL INSURANCE REQUIREMENTS (Pursuant NRS 244.33505 and NRS 268.0955) Business Name (Include any name doing business as) Type of Business Business Telephone Number Business Address City State Zip Code Federal Identification Number Contractor’s Board License Number Name of Principal Owner (Please Print) Principal Owner’s Telephone Number Principal Owner’s Address City State Zip Code Identified as: (Complete one section only) That the above identified business has obtained industrial workers’ compensation insurance as required by Chapter 616A to D, inclusive, of the Nevada Revised Statutes (NRS): Effective Date of Coverage Account Number That the above identified business is not subject to the provisions of Chapter 616A to D, inclusive, of the Nevada Revised Statutes, due to a statutory exemption or as a business which has no employees nor hires any independent contractor or subcontractor. That the above identified business has a valid certificate of self-insurance pursuant to Chapter 616A to D, inclusive, of Nevada Revised Statutes. Effective Date Certificate Number I declare that I have authority to act on behalf of the above-described business, and am applying for a license to operate said business as a(n): Individual Sole Proprietor Partnership Corporation Name of Applicant (Please Print) Applicant’s Telephone Number Applicant’s Residence Address City State Zip Code 1. If executed in Nevada: Pursuant to Nevada Revised Statutes (NRS) 53.045, I declare under penalty of perjury that the foregoing is true and correct. Executed on (date) (signature) 2. Except as otherwise provided in NRS 53.250 to 53.390, inclusive, if executed outside of Nevada: I declare under penalty of perjury under the law of the State of Nevada that the forgoing is true and correct. Executed on (date) (signature) D-25 (rev. 11/23) SIGN SIGN ---PAGE BREAK--- Form instruction and general information: 1. The top section will be completed with information about the business and ownership. 2. The middle section consists of three boxes. Only one box must be checked. Check the first box, if the business has obtained workers’ compensation insurance. Please provide the insurance policy effective date and policy number where indicated. Check the second box, if the business meets one of the statutory exemptions or the business has no employees nor hires any contractors/sub-contractors. Check the third box, if the business is self- insured with a valid certificate of insurance. Please provide the self-insured policy effective date and certificate number where indicated. 3. The next to bottom section please check the appropriate box indicating the license application type. Provide applicant information as indicated. 4. The bottom section contains two signature lines. Only one applicant signature and date will be provided. If the form is executed in Nevada, applicant will sign and date the first line. If the form is executed outside of Nevada, applicant will sign and date the second line. The provisions of Chapter 616A to D, inclusive, of the Nevada Revised Statutes require every person, firm, voluntary association, and private corporation, including any public service corporation, which has any person, subcontractor, or independent contractor, under contract of hire, to obtain industrial insurance coverage in Nevada or obtain a certificate of self-insurance from the Nevada Commissioner of Insurance. Subcontractors and independent contractors engaged in the same trade, business, profession or occupation as the hiring person or business, are by law considered to be employees. One exception to the requirement for industrial insurance is if you or your business hires no employees, subcontractors or independent contractors. You are not required to obtain industrial insurance coverage for the following employees: theatrical or stage performers; casual musicians; household domestics, farm, dairy, agricultural or horticultural laborers, or persons engaged in stock or poultry raising; voluntary ski patrolman; real estate brokers and/or salesmen; direct sellers; or clergy. Businesses which elect to obtain industrial insurance coverage for such persons, gain valuable rights and significantly reduce liabilities for injuries to these persons. A business which hires persons who are exempt from the provisions of Chapter 616A to 617, inclusive, of the Nevada Revised Statutes may be held liable in tort for injuries to those persons. A business which hires exempt persons may elect to obtain industrial insurance, including sole proprietor coverage and partnerships. IMPORTANT NOTICE: Pursuant to the provisions of NRS 616D.200(1): Any employer within the provisions of NRS 616B.633 who fails to provide, secure or maintain compensation as required by the terms of this chapter, is: for the first offense, guilty of a misdemeanor and for a second or subsequent offense committed within 7 years after the previous offense, guilty of a category D felony. Definitions for Purposes of this Affirmation: "Applicant" is the person executing this document. "Business Name" is the name under which the business will operate, including the identification of any other names under which the entity will do business. "Corporation" is a business which is incorporated in the state of Nevada or in any other state, and which is recognized as an active corporation by the Secretary of State for the State of Nevada. A Type of Business@ means the nature of business . . . "Individual" is a person who operates a business which hires no employees, subcontractors or independent contractors. "Partnership" is a business which is owned and operated by two or more individuals who share ownership rights to the net profits of the business and who share in all the liabilities of that business. A limited partnership is included in the term partnership if the limited partners are investors only, and do not perform services for the business. "Principal Owner" is the owner, sole operator, designated general partner, or resident agent for the corporation. "Sole proprietor" is a self-employed owner of an unincorporated business and includes working partners and members of working associations which may or may not hire employees. D-25 (rev. 11/23) ---PAGE BREAK--- CERTIFICATE OF BUSINESS - FICTITIOUS FIRM NAME File THIS FICTITIOUS FIRM NAME WILL EXPIRE IN 5 YEARS FROM DATE FILED Certificate filed on 20___ Expires on 20___ New Application Renewal of Existing Fictitious Firm Name Address Change (No Filing Fee) Name Change – Proof of Legal Name Change Required (No Filing Fee) Original THE UNDERSIGNED do/does hereby certify that (Name of individual, corporation, partnership or trust) mailing address for renewal (P.O. Box/Street) (City) (State) (Zip) is/are conducting located at (kind of business) (physical address) Nevada phone number under the fictitious name (City) (Zip Code) said firm is composed of the following person(s) whose name(s) and address(es) are as follows: Signature Date Signature Date Print Name Print Name Address (phone) Address (phone) Mailing Address if different from above Mailing Address if different from above City, State, Zip City, State, Zip Signature Date Signature Date Print Name Print Name Address (phone) Address (phone) Mailing Address if different from above Mailing Address if different from above City, State, Zip City, State, Zip STATE OF NEVADA, County of Nye I, Notary Public in and for the said County and State, residing therein, duly sworn, personally appeared known to me to be the person(s) whose name(s) subscribed to the within instrument, and acknowledged to me that he/they executed the same. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official seal the day and year in this Certificate first above written. Sworn before me on this day of Notary Public State of County of ---PAGE BREAK--- This page has been left blank intentionally. ---PAGE BREAK--- PAHRUMP VALLEY FIRE-RESCUE 2100 E. Walt Williams Dr. #100 Pahrump, NV 89048 -Fire Inspections - Certificate Of Occupancy/Life Safety - Inspection Application BUSINESS NAME: OWNER NAME: PHYSICAL ADDRESS: MAILING ADDRESS: BUSINESS PHONE: PHONE: EMAIL ADDRESS: CONTACT PERSON: PHONE: CONTACT PERSON’S EMAIL: TYPE OF BUSINESS: MOVE IN DATE: DATE: BUSINESS HOURS: LICENSED AS HEALTH CARE: LIQUOR LICENSE REQUIRED: HOME BASED BUSINESS: # OF EMPLOYEES: LIST CHEMICALS STORED & QUANTITY DO NOT RETURN TO FIRE DEPARTMENT. PLEASE RETURN TO: TOWN OF PAHRUMP 2100 E. Walt Williams Dr #100 Pahrump, NV 89048. MAKE CHECKS PAYABLE TO TOWN OF PAHRUMP FEES: $50.00 = $50.00 $50.00 $10.00 $50.00 Certificate of Occupancy (initial fee for new business or change of ownership) Life Safety Inspection (annually after initial inspection) Hazardous Materials (annually, if applicable) Temporary Permit (covers special events) Re-inspections (determined by Inspector) DATE INITIALS COMPLETED APP FEE Y / N Y / N Inspection fee covers the Initial Inspection and one Follow-Up Inspection, if needed. Re-Inspections are subject to additional fees. DO NOT WRITE BELOW THIS LINE FOR INSPECTORS USE ONLY 1st Inspection / N Y / N Occupancy Y / N Certificate Line Safety Y / N No. ---PAGE BREAK--- This page has been left blank intentionally. ---PAGE BREAK--- TOWN LOCATIONS A – Nye County Administration / Pahrump Town Office – 2100 E. Walt Williams Dr., Pahrump 89048 Suite 100 Administration & Commissioners (775) 751-7075 / Pahrump Town Office (775) 727-2815 B – Community Development Services (CDS) – 2041 E. Calvada Blvd. N, Pahrump 89048 Planning – Suite 1 – (775) 751-4249 / Building & Safety – Suite 2 – (775) 751-3773 Public Works – Suite 3 – (775) 751-6855 C – Human Resources / Finance / Natural Resources / Water District – 1981 E. Calvada Blvd., Pahrump 89048 Human Resources (775) 750-6301 / Finance (775) 751-6390 / Natural Resources (775) 751-4354 Water District (775) 727-3487 D – Health & Human Services & WIC / Veteran Services / Health Nurse – 250 N. Hwy. 160, Pahrump 89060 H & H Services (775) 751-7095 / WIC (775) 751-7077 / Veteran Services (775) 751-6372 Health Nurse (775) 751-7070 E – Pahrump Tourism – 400 N. Hwy. 160, Pahrump 89060 – (775) 727-2825 **Business Hours: Mon-Thurs 6 am – 2:30 pm Fri 6 am – 12 pm** F – Ian Deutch Government Complex – 1520 E. Basin Ave., Pahrump 89060 Sheriff’s Office (775) 751-7000 / Suite 104 Clerk (775) 751-7040 / District Attorney (775) 751-7080 Justice Court (775) 751-7050 G – Assessor / Treasurer / Recorder – 160 & 170 N. Floyd St., Pahrump 89060 Assessor – 160 N Floyd St. – (775) 751-7060 / Recorder – 170 N Floyd St., Suite 1 – (775) 751-6340 Treasurer – 170 N Floyd St., Suite 2 – (775) 751-4200 H – Animal Shelter – 1580 E. Siri Ln., Pahrump 89060 – (775) 751-7020 I – DMV – 1780 E. Basin Ave., Pahrump 89060 – (775) 727-4141 E H G F I D A B C