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OFU'fv West Windsor Township Fire & Emergency Services I, P. O. Box 38 West Windsor, NJ 08550 Phone 609- 799- 8735 Fax 609- 799- 8926 FIRE SAFETY PERMIT APPLICATION APPLICANT INFORMATION ( INCLUDE BUSINESS NAME AND ADDRESS): PHONE NUMBER: ACTIVITY BEING CONDUCTED (IF cooking—include type( s) of appliance cooking with) EXACT LOCATION OF ACTIVITY( INCLUDE NAME OF EVENT OR FESTIVAL IF APPLICABLE): DATES AND TIME DURATION ACTIVITY WILL OCCUR: RESPONSIBLE PARTY NAME & CONTACT INFORMATION: I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION PROVIDED IS CORRECT, AND THAT I AM THE OWNER OR DULY AUTHORIZED TO ACT IN THE OWNER' S BEHALF AND AS SUCH HEREBY AGREE TO COMPLY WITH THE APPLICABLE REQUIREMENTS OF THE FIRE CODE AS WELL AS ANY SPECIFIC CONDITIONS, LIMITATIONS AND/ OR SPECIAL INSTRUCTIONS IMPOSED BY WEST WINDSOR TOWNSHIP OR THE FIRE OFFICIAL. SIGNATURE TITLE DATE Any permit application that is received late (seven ( 7) days or less prior to the event), the PERM/ TFEEW/ LL DOUBLE THIS SECTION FOR DIVISION USE ONLY FIRE SAFETY PERMIT 0: DEP PERMIT FIRE RETARDANT CERTIFICATION UCC APPROVAL CERTIFICATE OF INSURANCE FEE CHECK NUMBER Permit Fees: Type I=$ 65. 00 Type II=$ 250. 00 Type III=$ 475. 00 Type IV=$ 625. 00
