Free Change Form - Nevada

Department of Business License
JACQUELINE R. HOLLOWAY
DIRECTOR 500 SOUTH GRAND CENTRAL PKY, 3RD FLOOR; P.O. BOX 551810 LAS VEGAS, NEVADA 89155-1810 (702) 455-4252; (800) 328-4813 FAX (702) 386-2168
http://www.co.clark.nv.us/business_license

CHECKLIST FOR APPLICATION FOR CHANGE OF BUSINESS LICENSE
Section 6.04.070 of the Clark County Code, provides guidelines for changes to existing business location, name, mailing address, officer changes and ownership changes. (Please note: Pursuant to section 6.04.070(d) of the Clark County Code, changes to business ownership of 50% or more requires a new license, and a new business license application must be completed.) I. All changes require the following: 1. The Application for Change of Business License form must be completed and signed by an owner or officer of the business. 2. A fee of $25 will be charged for each change on each license. Payment can be made by cash, check, or money order made payable to: Clark County Department of Business License. a. If renewing your license at the same time, please provide a separate check or money order for the license renewal fees and the change request fees. 3. Additional documents may be required for Regulated, Childcare, or Liquor & Gaming licenses. Please call (702) 455-3573 for further information. II. Business Location Change: 1. Preliminary zoning review. Contact Clark County Current Planning at (702) 455-4314. 2. The Fire Department Permit Survey form must be completed. 3. One of the following Proof of Rights to the business physical location: a. b. c. d. e. Lease or Rent: An executed lease or rental agreement signed by the property owner or landlord; or Sharing Space: A signed Letter of Authorization from lessee, business owner or officer; or Property Ownership: A copy of the deed, mortgage agreement, bill of sales; or Other Jurisdiction: If the new location is in a jurisdiction other than Unincorporated Clark County, provide a copy of the approved business license with the current address from that jurisdiction.

III. Business Name Change: A file stamped copy of the Fictitious Firm Name (DBA) from the Clark County Clerk's office, or a file stamped copy of the Amended Name Change articles filed with the Nevada Secretary of State. Business Owner Change: (Please note: Pursuant to section 6.04.070(d) of the Clark County Code, changes to business ownership of 50% or more requires a new license, and a new business license application must be completed.) 1. A notarized letter signed by an owner is acceptable; 2. A complete list of owners and ownership percentages is required per Clark County Code; 3. A stamped copy of the Resolution or Minutes filed with Nevada Secretary of State is acceptable; 4. A stamped copy of the new DBA filed with the Clark County Clerk's office is acceptable; and 5. For an owner's name change, a copy of the file stamped marriage or divorce decree is acceptable. IV. Officer Change: 1. Submit documentation of new officer(s) or the Amended Resolution filed with the Nevada Secretary of State. V. Mailing Address Change: 1. Complete the section for the new mailing address and have it signed by an Owner or Officer of the business. This change requires no additional documentation or fees.

* INCOMPLETE DOCUMENTATION FOR CHANGE REQUEST WILL BE RETURNED *
1/24/06 Application for Change of Business License (Checklist).rtf

Department of Business License
JACQUELINE R. HOLLOWAY DIRECTOR 500 SOUTH GRAND CENTRAL PKY, 3RD FLOOR; P.O. BOX 551810 LAS VEGAS, NEVADA 89155-1810 (702) 455-4252; (800) 328-4813 FAX (702) 386-2168
http://www.co.clark.nv.us/business_license

APPLICATION FOR CHANGE OF BUSINESS LICENSE
APPLICABLE LICENSE CHANGES AND FEES
Check all that apply: Change of Business Name - $25 Fee Change of Business Location/Address - $25 Fee Change of Business Owners - $25 Fee Change of Business Officers - No Charge Change of Business Mailing Address - No Charge

(Please note: Pursuant to section 6.04.070(d) of the Clark County Code, changes to business ownership of 50% or more requires a new business license, and a new business license application must be completed.) If you have additional licenses, please list the license numbers and include $25.00 for each change on each license.

CHANGE OF BUSINESS NAME AND/OR CHANGE OF LOCATION
Clark County Business License No.: Old Business Name: Old Business Address: City/State New Mailing Address: Business Telephone No. Zip Code New Business Information: New Business Name: New Business Address: City/State Zip Code Zip

CHANGE OF MAILING ADDRESS City/State Effective Date Of Change:

CHANGE OF BUSINESS OWNERS
For changes to ownership of 50% or more, you must complete a new business license application form.

Previous Owners Name: (First, M.I., Last) Percentage of Ownership: Address City/State SSN: (optional) Zip Code Date of Birth (optional)

New Owners Name: (First, M.I., Last) Percentage of Ownership Address City/State Date of Birth (optional)

Zip Code

SSN: (optional) CHANGE OF BUSINESS OFFICERS (do not include owners) Old Officer's Name/Title: New Officer's Name/Title: Address: City/State Telephone No. Address: City/State Zip Code Telephone No. SIGNATURES (requires signatures of owner, officer, authorized or legal signer) Signed Name: Print Name: Date: Zip Code Signed Name: Print Name: Date:

IF YOU REQUIRE ADDITIONAL INFORMATION, PLEASE CALL OUR LICENSING DIVISION at (702) 455-0174

Reminder: Don't forget to change the business name, location and/or ownership with the appropriate State Agency(s)

02/15/06 Application for Change of Business License (Changes and Fees).rtf

CLARK COUNTY FIRE PERMIT SURVEY FORM
PROJECT ADDRESS (BUSINESS LOCATION) ______________________________________________________________ PROJECT NAME (BUSINESS NAME) _________________________________________ CONTACT PERSON ____________________________________________ INITIATING AGENCY: AIR QUALITY BUILDING DIVISION DATE _____________________ ASSESSOR'S PARCEL NUMBER(S) _______________________________________________________________________ PHONE # ___________________________

(Check Box, Agency Application/Permit #, and Agency Signature Required below) BUSINESS LICENSE CURRENT PLANNING FIRE DEPARTMENT HEALTH DISTRICT

INITIATING AGENCY APPLICATION # or PERMIT # ______________________________________________________ INITIATING AGENCY SIGNATURE __________________________________________________ CHECK "Yes" or "No" for each item below that your building/business/project includes. YES NO £ Water supplied by a well or private water system 1. £ £ Propane tank(s) 2. £ £ Aboveground or underground flammable/combustible liquid tank(s) 3. £ £ High-piled storage* (see definition below) 4. £ £ Spray paint booths 5. £ £ Medical Gas Systems 6. £ £ Combustible Dust Producing Operations 7. £ £ Chemicals ­ Storage, Manufacture, or Use ** £ 8. Fire Dept. Review/Comments Signature is only required for any "Yes" response.
v

Fire Dep t. Rev iew/Co mmen ts

Sig n atu re

Date

A "Yes" response to any of the above conditions may require the applicant to obtain a permit from the Clark County Fire Department (CCFD). CONTACT CCFD PLANSCHECK AT (455-7100) IMMEDIATELY for permit requirements. v A "Yes" response to conditions #7 and #8 also requires Signature of Building Division below and may require approval of a Special Use Permit through the Current Planning Division. NOTE: Title 30, Section 30.04.160, provides for the revocation of any land use approval not in compliance with Codes. PRINT NAME _________________________________ CIRCLE ONE: ATTENTION: Property, Building, or Business Owner SIGNATURE ___________________________________________ ~ Occupant's Legal Representative ~ Responsible Party

FAX COMPLETED FORM TO CLARK COUNTY FIRE DEPARTMENT AT (702) 735-0775

* High-Piled Storage is storage of combustible materials in closely packed piles or combustible materials on pallets, in racks or on shelves, where the top of storage is greater than 12 feet (3658 mm) in height. High-piled combustible storage also includes certain high-hazard commodities, such as rubber tires, Group A plastics, flammable liquids, idle pallets and similar commodities, where the top of storage is greater than 6 feet in height. ** Refer to the Clark County Fire Department's "Hazardous Materials Systems" Guideline. For Development Services ­ Building Division Use Only Hazardous Occupancy Required? YES______ NO______ If YES, then Special Use Permit Required.

Building Division Signature ___________________________________________ New Construction Addition Remodel PAC Process Walk-thru Commercial Residential

~ DISTRIBUTION ~ CUSTOMER AIR QUALITY MANAGEMENT BUSINESS LICENSE DEPARTMENT FIRE DEPARTMENT HEALTH DISTRICT DEVELOPMENT SERVICES: BUILDING PLANS EXAMINATION ZONING PLANSCHECK CURRENT PLANNING
Revised 1/10/06