Lease Application - Fairbanks North Star Borough
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1
2Fairbanks North Star Borough
P.O. Box 71267
Fairbanks, Alaska 99707
(907)459-1241 Phone
(907) 459-1122 Fax
land@fnsb.us
APPLICATION FOR A LEASE
APPLICANT INFORMATION
Name and mailing address of APPLICANT:
Name and mailing address of the AUTHORIZED SIGNER:
(If different from applicant)
Name:
Name:
Address:
Address:
Business/Agency Name (if applicable)
Incorporated?
Yes
No
Telephone: (
)
Where?
When?
Fax No.: (
)
AK Business License No.
Email:
Taxpayer I.D. #:
PREMISES, TERM, AND REQUESTED USES
Premises: Description of property requested.
For what purpose do you plan to use the property?
List all specific uses planned
(If a block and lot number do not exist, attach a drawing showing the
(monitoring wells, utility
location and all applicable dimensions)
installations, road work, special event, etc.)
Block/Lot:
Subd:
Tax Lot:
Sec:
T:
R:
Term Requested:
Desired Begin Date:
Desired Term (yrs):
IMPROVEMENTS
Do you plan to construct improvements on the premises?
Yes
No
If yes, attach a site plan drawn to scale showing all dimensions. Describe purpose of proposed improvements (example):
Estimated total value of proposed improvements when completed:
$
Proposed construction dates:
Beginning:
Ending:
Source of Funding:
Grant:
Other:
BEFORE SUBMITTING THIS APPLICATION HAVE YOU:
Provided all required documentation?
Attached a site plan?
Signature:
Attached an application fee?
Signed application?
Title:
Date:
Note: The Borough reserves the right to return incomplete applications or require additional information.
FOR OFFICE USE ONLY
Date entered into Issue Track:
New File No.: UA
Initials:
Acknowledgement Date:
By:
Email
Letter
LEASE Application Form
Two pages
Rev: Sept 2014
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