State of Nevada
Manufactured Housing Division
2501 E Sahara Ave. Room 204
Las Vegas, Nevada 89104
Page of FEE ENCLOSED $
Application For: Commercial Coach (CC)
Plan Approval Label or Insignia System Approval
Applicant: Telephone:
Address:
(Street, City, State, Zip)
I hereby certify that each insignia will be affixed only to the unit to which it is assigned, as itemized below, and to which prior Division approval has been given and herewith consent to all necessary inspections incident to the issuance of the insignia.
Date Authorized Agent
Signature
IMPORTANT – EACH INSIGNIA IS ASSIGNED TO A SPECIFIC UNIT
A fee for each insignia is due with application. Not subject to refund. Make checks payable to:
NEVADA MANUFACTURED HOUSING DIVISION
Model
/Plan Approval #
/Serial Number
/Insignia #
(Dealer or Purchaser, City and State)
Remarks: