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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.