Form CCS-FRM-274 Multi-Tenant Registration Application and Renewal - City of Dallas, Texas

Form CCS-FRM-274 or the "Multi-tenant Registration Application And Renewal" is a form issued by the City of Dallas Code Compliance Department.

The form was last revised in October 1, 2015 and is available for digital filing. Download an up-to-date Form CCS-FRM-274 in PDF-format down below or look it up on the City of Dallas Code Compliance Department Forms website.

ADVERTISEMENT
______________
Account Number:
Multi-Tenant Registration Application
Renewal
New
IMPORTANT!!! - A CERTIFICATE OF REGISTRATION WILL NOT BE ISSUED UNTIL ALL CURRENT FEES AND FINES RESULTING FROM THE OPERATION
OF THE MULTI-TENANT PROPERTY (OR PROPERTIES) ARE PAID OR SETTLED. ALL OF THE INFORMATION REQUIRED IN THE APPLICATION MUST BE
PROVIDED IN ORDER TO PROCESS THE REGISTRATION.
(FOR OFFICE USE ONLY)
______________________________
_______/______/_______
ACCOUNT NUMBER:
DATE PAID:
$_________________
: ___________________________
LICENSE FEE PAID:
INSTRUMENT NUMBER
INSTRUMENT TYPE: [ ] CK [ ] MO [ ] CC [ ] CASH
_____________________________________________________________
PAYOR:
(If different than customer/applicant, capture address, C/S/Z, phone number)
___________________________________________________________
ADDRESS:
___________________________ STATE: _____ ZIP: __________-________
_______-__________
CITY:
PHONE: (______)
This application must be completed by the person who owns, operates, or controls the property, and returned with the applicable,
nonrefundable fee of $6.00 per unit, whether occupied or unoccupied. Please update any information that is incorrect on this application in
the spaces provided below.
Applicant’s Name:
Applicant’s Phone No:
Applicant’s Address / Zip Code:
Multi-Tenant Property or Properties owned by an: ___Individual ____Corporation ____Partnership ____ Other: _______________________
(Specify)
__________________________________________________________________________________________________
Property Owner(s) of Record:
Property Owner(s) Address:
___________________________________________________________________________________________________
Property Owner(s) Business Phone: _________________________ Fax: ___________________ Email: ____________________________________
If this property is owned by a corporation, provide the following information:
1. Name of Corporation’s Registered Agent: ___________________________________Phone: ____________________ Fax: ____________________
2. Registered Agent Address: __________________________________________________________________________________________________
3. Name of Corporation’s President: _________________________________________ Phone: ____________________ Fax: ____________________
4. Corporation’s President Business Address:____________________________________________________________________________________
If property owned by a partnership or other business association, provide name, address and telephone number of a high managerial agent. “High
Managerial Agent” means partner(s) in a partnership, officer(s) of a business association, director(s) of a business association, or any agent/employee
who has the duties of such responsibility that the agent’s/employee’s conduct represents the policy of the partnership or business association.
Name(s) of High Managerial Agent(s): ___________________________________________________________________________________________
Job Title of Managerial Agent(s): _______________________________________________________________________________________________
Business Address(s) of High Managerial Agent: __________________________________________________________________________________
________________________________________________________________________
Phone: ____________________________________________
I am the person who owns, controls, or operates the Multi-Tenant property that is the subject of this application. I have read the completed application and know the same
is true and correct and hereby agree that, if a certificate of registration is issued, I will comply with all applicable provisions of Chapter 27 of the Dallas City Code, as
amended, and all applicable state laws. I accept responsibility for payment of all fees and fines that may result from the operation of the Multi-Tenant property.
Signature of Owner/Operator/Person in Control (Required)
)
Driver’s License or Identification Number – Issuing State (Required
Page 1 of 2
CCS-FRM-274
Effective Date 10/1/2015
Rev 7
______________
Account Number:
Multi-Tenant Registration Application
Renewal
New
IMPORTANT!!! - A CERTIFICATE OF REGISTRATION WILL NOT BE ISSUED UNTIL ALL CURRENT FEES AND FINES RESULTING FROM THE OPERATION
OF THE MULTI-TENANT PROPERTY (OR PROPERTIES) ARE PAID OR SETTLED. ALL OF THE INFORMATION REQUIRED IN THE APPLICATION MUST BE
PROVIDED IN ORDER TO PROCESS THE REGISTRATION.
(FOR OFFICE USE ONLY)
______________________________
_______/______/_______
ACCOUNT NUMBER:
DATE PAID:
$_________________
: ___________________________
LICENSE FEE PAID:
INSTRUMENT NUMBER
INSTRUMENT TYPE: [ ] CK [ ] MO [ ] CC [ ] CASH
_____________________________________________________________
PAYOR:
(If different than customer/applicant, capture address, C/S/Z, phone number)
___________________________________________________________
ADDRESS:
___________________________ STATE: _____ ZIP: __________-________
_______-__________
CITY:
PHONE: (______)
This application must be completed by the person who owns, operates, or controls the property, and returned with the applicable,
nonrefundable fee of $6.00 per unit, whether occupied or unoccupied. Please update any information that is incorrect on this application in
the spaces provided below.
Applicant’s Name:
Applicant’s Phone No:
Applicant’s Address / Zip Code:
Multi-Tenant Property or Properties owned by an: ___Individual ____Corporation ____Partnership ____ Other: _______________________
(Specify)
__________________________________________________________________________________________________
Property Owner(s) of Record:
Property Owner(s) Address:
___________________________________________________________________________________________________
Property Owner(s) Business Phone: _________________________ Fax: ___________________ Email: ____________________________________
If this property is owned by a corporation, provide the following information:
1. Name of Corporation’s Registered Agent: ___________________________________Phone: ____________________ Fax: ____________________
2. Registered Agent Address: __________________________________________________________________________________________________
3. Name of Corporation’s President: _________________________________________ Phone: ____________________ Fax: ____________________
4. Corporation’s President Business Address:____________________________________________________________________________________
If property owned by a partnership or other business association, provide name, address and telephone number of a high managerial agent. “High
Managerial Agent” means partner(s) in a partnership, officer(s) of a business association, director(s) of a business association, or any agent/employee
who has the duties of such responsibility that the agent’s/employee’s conduct represents the policy of the partnership or business association.
Name(s) of High Managerial Agent(s): ___________________________________________________________________________________________
Job Title of Managerial Agent(s): _______________________________________________________________________________________________
Business Address(s) of High Managerial Agent: __________________________________________________________________________________
________________________________________________________________________
Phone: ____________________________________________
I am the person who owns, controls, or operates the Multi-Tenant property that is the subject of this application. I have read the completed application and know the same
is true and correct and hereby agree that, if a certificate of registration is issued, I will comply with all applicable provisions of Chapter 27 of the Dallas City Code, as
amended, and all applicable state laws. I accept responsibility for payment of all fees and fines that may result from the operation of the Multi-Tenant property.
Signature of Owner/Operator/Person in Control (Required)
)
Driver’s License or Identification Number – Issuing State (Required
Page 1 of 2
CCS-FRM-274
Effective Date 10/1/2015
Rev 7
Account No.
Customer No.
Multi-Tenant Property Information Form
Attach to the Multi-Tenant Registration Application
Renewal
New
IMPORTANT!!! – A separate form must be completed for each Multi-Tenant Property being registered Use additional copies of this form to register more
than one Multi-Tenant Property. Attach form(s) to the Multi-Tenant Registration Application.
Name of Multi-Tenant Property:
Also known as (Aka):
Address of Multi-Tenant Property:
Property Phone No:
Property Fax No:
Property E-Mail:
No. of Buildings: _________ No. of Dwelling Units: ____________ No. of Pools: __________
No. of Spas: ______________
Total No. of Bedrooms: ______________ (A unit with no separate bedroom will be counted as one bedroom)
Current Occupancy Rate Expressed as a Percent: ________________% Certificate of Occupancy #_______________________________.
Is the owner an entity? [ ] Yes [ ] No
If yes, a copy of the documents establishing the business must be submitted with this application.
Type of Property:
[ ] Apartment [ ] Boarding Home [ ] Three-plex [ ] Four-plex [ ] Group Home [ ] Loft [ ] Town home
[ ] Condo – Individual Unit (Suite) Numbers of Rental Units must be noted here __________________________________________
Type of Boarding Home:
[ ] Handicapped Group Dwelling [ ] Lodging or Boarding House [ ] Residential Hotel [ ] Group Residential Facility
[ ] Extended Stay Hotel or Motel
Phone
:
Property Manager’s Name:
_______________________________________________
______________________
Property Manager’s Address:
Phone:
_______________________________________________
______________________
Do you currently offer recycling to your residents? [ ] Yes
[ ] No
The Multi-Tenant manager / person in charge must also provide the following information if applicable:
Name of Property Lien holder(s):
Address of Property Lien holder(s):
Phone #s’ of Property Lien Holders:
Name of Insurance Provider:
Phone
Address of Insurance Provider:
Name of Crime Watch Attendant Designee:
Phone
Address of Crime Watch Designee:
Alternate Contact Name/Address/Phone:
I am the person who owns, controls, or operates the Multi-Tenant property that is the subject of this application. I have read the completed application and know the same
is true and correct and hereby agree that, if a certificate of registration is issued, I will comply with all applicable provisions of Chapter 27 of the Dallas City Code, as
amended, and all applicable state laws. I accept responsibility for payment of all fees and fines that may result from the operation of the Multi-Tenant property.
Signature of Owner/Operator/Person in Control (Required)
Driver’s License or Identification Number – Issuing State (Required
)
Page 2 of 2
CCS-FRM-274
Effective Date 10/1/2015
Rev 7

Download Form CCS-FRM-274 Multi-Tenant Registration Application and Renewal - City of Dallas, Texas

1454 times
Rate
4.6(4.6 / 5) 73 votes
ADVERTISEMENT
Page of 2