Renewed Not Renewed

New In Review Payment Requested Paid Approved Issued Denied

New Renewal Location Change

Sole Proprietorship Corporation Partnership LLC None - Applicant Only

AL AK AZ AR CA CO CT DE FL HI ID IL IA KS KY ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY AS DC FM GU MH MP PW PR VI GA

Yes No

Pass Fail

Pass Fail

Yes No

Yes No

Yes No

Own Lease

Yes No

Yes No

Yes No

Phone # *

Name *

Alarm Company Information

Address *

# of Employees *

Email *

Block *

If so, length of lease

***Payment will NOT be requested until your application has been approved & accepted.***
Please monitor your e-mail for the Payment Request e-mail.
***Please DO NOT SUBMIT DUPLICATE REQUESTS.***

Central Station

Occupancy Load *

City *

Attach any of the following documents as PDF, JPG OR JPEG. Additional documents may be requested after review.

1. Certificate of Occupancy
2. Copy of certificate or license issued by State of New Jersey or any governmental agency.
3. For 501C Organizations: A copy of a valid letter from the IRS verifying the not for profit status and a copy of a current good standing certificate issued by the State of New Jerseyand Good Standing Certificate.
4. If operation involves any flammable/combustible/hazardous materials: provide MSDS sheets

Involves Flammable/Hazardous Materials? *

Business Details

Type of Ownership *

Application Type *

Do you have an Alarm Company? *

Medical

Any changes from previous mercantile use? *

Other

Address *

State *

Flood

# of Exits *

Types of Alarms Monitored (Select all that apply)

Own or Lease the building? *

Supervisor City *

Require Sprinklers? *

Does alarm reset itself?

Supervisor Name *

Days and Hours of Operation? *

Use the table below to add other Business Owners.
1. If a corporation, give names and addresses of president and secretary
2. If a partnership, give names and addresses of all partners
3. If an LLC, give the name(s) and addresses of the managing member(s)

Status of Last Health Inspection *

Supervisor State *

Title *

Business Name *

NJ State Tax ID # *

All Real Estate Taxes Paid and Current? *

Lot *

Outstanding Zoning/Planning Violations? *

Emergency Contacts Details

Building Owner / Managing Agent of Property Details

Alarm Company

State *

Panic/Hold-up

Supervisor ZIP *

State *

Sq. Footage of Lot *

Federal Tax ID # *

Phone # *

Is alarm audible?

Fee Schedule

Last Name *

I (we) hereby certify that I (we) have read this application thoroughly and the information contained herein is true and accurate. I (we) understand that I (we) may not use or occupy the property until inspections are conducted and both Business Certificate of Occupancy and Zoning Certificate are issued for such use/occupancy.

Business Registration Ecode

Phone Number

# of Curb Cuts *

Application Fee

Phone # *

Address *

Certification

Date of Last Fire Inspection *

How long will alarm sound before resetting? (Time in Minutes)

ZIP *

Attach your documents

Other Business Details

Applicant Signature *

Business Owner / Applicant Details

Date of Last Health Inspection *

Supervisor Address *

# of Parking Spaces *

Business Description *

Fire

City *

First Name *

City *

Phone Number

Square Feet *

Burglary

Email *

ZIP *

Type of Business *

ZIP *

Status of Last Fire Inspection *

Temperature