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The following approvals shall be initiated by the applicant prior to acceptance of the application:
City of Fallon Variance
☐Approved ☐N/A
State Health Department (if building involves food & drink handling)
☐Approved ☐N/A
State and Local Fire Marshal
☐Approved ☐N/A
NDOT (if highway access required to lot)
☐Approved ☐N/A
Geotechnical/Engineering Report
☐Approved ☐N/A
I understand that this application does not guarantee permit issuance nor allow work to commence. I understand and agree that
the City of Fallon does not enforce C.C.&R.’s and has no obligation to explain every requirement and ordinance to me prior to my
project. I certify that the information provided is true and correct to the best of my knowledge and I am authorized to submit this
application for review. I agree to comply with all ordinances and laws regulating work in the City of Fallon. I certify that the work
to be done under this permit is for the purpose of improving the property stated; that I am familiar with the requirements of the
adopted building codes of the City of Fallon, as affecting this work and that I will call for required inspections. Construction must
be performed by a contractor licensed in the State of Nevada for the work performed except for Home Owner/Builders. I further
acknowledge that the Department of Building Inspection has made no inquiry as to the status of legal title to this land beyond my
representations and herby agree to hold the City of Fallon and the Department of Building Inspection harmless in the event any
person claiming paramount title should make a claim based upon this permit against the City of Fallon and the Department of
Building Inspection. I agree to save, indemnify and keep harmless the City of Fallon and its officers, employees and agents against
all liabilities, judgments, costs and expenses which accrue against the City in consequence of the granting of this authorization. I
further certify that I am the owner or the owner’s authorized agent:
_________________________ _____________________________ ______________
Print Applicant Name Applicant Signature Date
THIS AUTHORIZATION SHALL BECOME VOID IF NOT ACTED UPON WITHIN SIXTY DAYS OF ISSUANCE, OR IF CONSTRUCTION IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED, AND MAY BE VOIDED IF
INCORRECT INFORMATION OR ADDITIONAL INFORMATION IS DISCOVERED THAT MAY JUSTIFY THE SAME.
TO BE COMPLETED BY BUILDING DEPARTMENT
_________________________ ______________
Accepted By Date
Elevation Certificate
☐Required ☐N/A
_________________________ $_____________________
Permit Number Permit Cost
Notes:
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signature
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