2. TOWNSHIP OF PLAINSBORO
   Department of Code Enforcement
   Division of Fire Safety
   641 Plainsboro Road
   Plainsboro, NJ 08536
   609-799-0909 ext. 2545
4. Date:*
   Date:
5. Registration #:
6. Inspection:
   Office Use Only
8. Block:
9. Lot:
11. Business Name:*
13. Address:*
14. Suite #:
16. City:*
17. State:*
18. Zip Code:*
20. Phone Number:*
21. Email Address:*
23. Business Owner's Name:*
25. Person to Receive Certified Mail or Other Notices:*
    No P.O. Box Address
27. Address:*
28. City:*
30. State:*
31. Zip Code:*
33. Briefly Describe the Nature of Business:*
34. Square Footage of Business:*
36. Please Provide Two Contacts for any Emergencies after Business Hours:*
    Name and Telephone Number
38. Billing/Mailing Address if Different From The Business Address as Listed:
40. Address:
41. City:
43. State:
44. Zip Code:
46. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
48. Electronic Signature:*
Leave This Blank:


50. Submit

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