Fire Inspection Registration Application

Business Name *

Business Address *

Business Owner's Name *

Business Owner's Residence *

Business Owner's Phone Number *

Business Owner's Email *

Building/Property Owner's Name *

Building/Property Owner's Address *

Building/Property Owner's Phone Number *

Building/Property Owner's Email *

Emergency Contact Name *

Emergency Contact Address *

Emergency Contact Phone Number *

Emergency Contact Email *

Agent to Contact to Schedule Inspections, Send Violations, Correct Violations Name *

Agent to Contact to Schedule Inspections, Send Violations, Correct Violations Address *

Agent to Contact to Schedule Inspections, Send Violations, Correct Violations Email Address *

Building Information Section

Square Footage of Your Business *

# of Stories/Levels in Building *

Describe Business Use: *

Apartment/Dwelling Unit(s) Amount (if any) *

Owner/Agent's Signature *

Pursuant to NJAC 5:70-2 This application must be Returned to the Winslow Township Fire Marshal's Office within 30 Days.

SECTION BELOW TO BE COMPLETED BY THE FIRE MARSHAL

Registration Number

Permits Required?

Construction Type

Use Group

Registration Fee

* - denotes required field

WINSLOW TOWNSHIP FIRE DEPARTMENT