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TOP Vacant Bldg Registration & Plan Revised 3/5/12 Page 1 of 2 Town of Pahrump 2100 E. Walt Williams Drive, Suite 100 Pahrump, NV 89048 Phone: [PHONE REDACTED] PAHRUMP TOWN ORDINANCE #56 REGISTRATION FOR VACANT BUILDINGS OBLIGATION TO REGISTER VACANT BUILDINGS: Whenever any building in the Town is vacant for more than sixty (60) days or whenever any building in the Town is vacant and such buildings contain one or more of the public nuisances as described in PTO#56, then the owner of such building shall, within ten (10) days of notification, register such building as a vacant building and submit a vacant building plan. PROPERTY OWNER NAME: PROPERTY OWNER ADDRESS: PROPERTY OWNER PHONE: LOCAL AGENT OR REPRESENTATIVE: CONTACT INFORMATION OF AGENT: LIST ANY PERSON WITH LEGAL INTEREST IN PROPERTYAND/OR PREMISES. INCLUDE NAME, ADDRESS AND PHONE CONTACT: (If more room is needed to list more contacts, please use other side or attach list.) ASSESSOR PARCEL NUMBER (APN): PHYSICAL ADDRESS OF PROPERTY/PREMISES: DATE BUILDING/PREMISES BECAME INITIAL REGISTRATION RENEWAL RECEIPT REQUESTED (If a receipt is requested, MUST provide an email address or fax number below. No receipts will be mailed.) EMAIL ADDRESS FAX NUMBER FOR OFFICE USE ONLY VACANT BUILDING PLAN ATTACHED: YES NO FILING FEE $ Date: Received by: Check ---PAGE BREAK--- TOP Vacant Bldg Registration & Plan Revised 3/5/12 Page 2 of 2 Town of Pahrump 2100 E. Walt Williams Drive, Suite 100 Pahrump, NV 89048 Phone: [PHONE REDACTED] TOWN OF PAHRUMP VACANT BUILDING PLAN Property Address: Assessor’s Parcel Number (APN): Current Status of the Building: Yes No Doors Secured Windows Secured Detached Buildings Secured Trash Removed Yard Maintenance Scheduled Winterization complete Photos Attached (minimum of two photos for four sides of the existing buildings) On Off Electric, Provider Propane, Provider Water/Sewer, Provider What is the scheduled date of re-occupancy? Is building to be sold or rented? Is building on the market for sale? Is building to be demolished? Plan of action for exterior building maintenance: Specific timeline of completion of correction/improvement. What improvements are planned? Specific timeline of completion of correction or improvements. This form is valid for 6 months from the date of filing. After 6 months new registration is required. I hereby authorize a Town representative to conduct a compliance inspection on the above mentioned property. Signature Printed Name Date