CDA - Annual Cannabis Permit (ACP) Renewal Application

Annual Cannabis Permit (ACP) Renewal Application
ACP or CCP Number*
XXXXnn-nnnn
Site Address

Street Address

Street Address Line 2

CityState

Zip Code
APN:
APN (additional):
Employees

YesNo
Employment Type

TemporaryFull Time
Number of Employees
Tax Identification Number
ADP or CCP Reference Number
Change in Site Activities from ADP or CCP Approval

YesNo
Is your Surety Bond still in effect?

YesNo
Complete Description of Cultivation/Activities

0/100

Property Owner Name
Owner Name
Owner Address

Street Address

Street Address Line 2

CityState

Zip Code
Owner Phone Number
Owner Fax
Owner Email
(Owner) Resident at Cannabis Cultivation Location

YesNo

Applicant/Agent
Same as Property Owner
Applicant/Agent Name
Applicant/Agent Address

Street Address

Street Address Line 2

CityState

Zip Code
Applicant/Agent Phone Number
Applicant/Agent Fax
Applicant/Agent Email
(Applicant/Agent) Resident at Cannabis Cultivation Location

YesNo

Change in Property Residents From ADP/CCP Approval

(attach additional sheets is needed)
Name (Change in Prop. Residents)
Address (Change in Prop. Residents)

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number (Change in Prop. Residents)
Fax (Change in Prop. Residents)
Email (Change in Prop. Residents)
Are there additional residents?

YesNo
Upload Additional Resident's Information

Cancelof

Change in Entities With Financial Interest From ADP/CCP Approval

(attach additional sheets is needed)
Name (Change in Entities)
Address (Change in Entities)

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number (Change in Entities)
Fax (Change in Entities)
Email (Change in Entities)
Additional Entities
Upload Additional Entities' Information

Cancelof

By initialing here, you attest to the following:*

Clear
REVIEW AND CHECK ALL OF THE FOLLOWING

I certify that the project parcel is in full compliance with all regulations shown in the County’s Commercial Medical Cannabis OrdinanceI acknowledge that if the Annual Cannabis Permit (ACP) does not remain current/active that the Commercial Cannabis Permit (CCP) or Administrative Development Permit (ADP) issued on the property will become void.I acknowledge that that this permit may be revoked at any time at the discretion of the Community Development Agency Director or their designee.I hereby authorize the County of Nevada Community Development Agency employees and/or any other appropriate County or State agency or local districts to enter the property to conduct site inspections and investigations as set forth in this permit that may be issued on the basis of this application. I further agree to pay any fee for such inspection or investigation that occurs on the subject property.
Hidden Checked

I certify that the project parcel is in full compliance with all regulations shown in the County’s Commercial Medical Cannabis OrdinanceI acknowledge that if the Annual Cannabis Permit (ACP) does not remain current/active that the Commercial Cannabis Permit (CCP) or Administrative Development Permit (ADP) issued on the property will become void.I acknowledge that that this permit may be revoked at any time at the discretion of the Community Development Agency Director or their designee.I hereby authorize the County of Nevada Community Development Agency employees and/or any other appropriate County or State agency or local districts to enter the property to conduct site inspections and investigations as set forth in this permit that may be issued on the basis of this application. I further agree to pay any fee for such inspection or investigation that occurs on the subject property.
Please upload the following documents: Proof of Surety Bond, Toilet Contract (if applicable), Biological Memos (if applicable)

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APPLICANT’S DECLARATION

By my signature below, I certify that I am the property owner or authorized to act on the property owner’s behalf. I have read this permit application and the information I have provided is true and correct. I agree to comply with all applicable County ordinances and State laws.
Printed Name*
Signature*
Date*

MonthDayYear
Should be Empty:

Annual Cannabis Permit (ACP) Renewal Application

Property Owner Name

Applicant/Agent

Change in Property Residents From ADP/CCP Approval

Change in Entities With Financial Interest From ADP/CCP Approval

APPLICANT’S DECLARATION