143 143 SISOLAK TERRY REYNOLDS Governor STATE OF NEVADA DEPARTMENT OF BUSINESS AND INDUSTRY NEVADA TRANSPORTATION AUTHORITY PETITION TO DEVIATE To Deputy Commissioner Nevada Transportation Authority C ID: 897814
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1 SISOLAK TERRY REYNOLDS
SISOLAK TERRY REYNOLDS Governor STATE OF NEVADA Director B&I DEPARTMENT OF BUSINESS AND INDUSTRY NEVADA TRANSPORTATION AUTHORITY PETITION TO DEVIATE To: Deputy Commissioner, Nevada Transportation Authority Company Name: Telephone: Address: DAWN GIBBONS Chairman GEORGE ASSAD Commissioner DAVID NEWTON Commissioner Reason for request: Signature: Date: Printed Name a n d T i t l e __________________________________________________________________ CPCN: __________ For NTA Office Use Only Docket # Assigned Hearing Officer: $50 Filing Fee $50 Interim Authority Fee Las Vegas: 3300 W. Sahara Ave, Suite 200, Las Vegas, Nevada 89102 (702) 486‐3303 Fax (702) 486‐2590 Reno: 1755 East Plumb Lane, Suite 229, Reno, Nevada 89502 (775) 688‐2800 Fax (775) 688‐2802 Website: www.nta.nv.gov STEVE SISOLAK Governor STATE OF NEVADA DEPARTMENT OF BUSINESS AND INDUSTRY NEVADA TRANSPORTATION AUTHORITY PETITION TO DEVIATE To: Deputy Commissioner, Nevada Transportation Authority Company Name: Telephone: Mailing Address: TEREYNOLDS Director DAWN IBBONS Chairman GEORGE SSAD Commissioner Reason for request: Signature: Date: Printed Name a n d T i t l e : __________________________________________________________________ CPCN: __________ For NTA Office Use Only Docket # Assigned Hearing Officer: $50 Filing Fee $50 Interim Authority Fee Las Vegas: 3300 W. Sahara Ave, Suite 200, Las Vegas, Nevada 89102 (702) 486‐3303 Fax (702) 486‐2590 Reno: 1755 East Plumb Lane, Suite 229, Reno, Nevada 89502 (775) 688‐2800 Fax (775) 688‐2802 Website: www.nta.nv.gov STEVE SISOLAK Governor STATE OF NEVADA DEPARTMENT OF BUSINESS AND INDUSTRY NEVADA TRANSPORTATION AUTHORITY PETITION TO DEVIATE To: Deputy Commissioner, Nevada Transportation Authority Company Name: Telephone: Mailing Address: TERRY REYNOLDS Director B&I DAWN GIBBONS Chairman GEORGE ASSAD Commissioner DAVID Commissioner Reason for request: Signature: Date: Printed Name a n d T i t l e : __________________________________________________________________ CPCN: __________ For NTA Office Use Only Docket # Assigned Hearing Officer: $50 Filing Fee $50 Interim Authority Fee Las Vegas: 3300 W. Sahara Ave, Suite 200, Las Vegas, Nevada 89102 (702) 486‐3303 Fax (702) 486‐2590 Reno: 1755 East Plumb Lane, Suite 229, Reno, Nevada 89502 (775) 688‐2800 Fax (775) 688‐2802 Website: www.nta.nv.gov