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TOWNSHIP OF DENNIS |
Information Required:
Initial Application:___________________________ Renewal:_____________________
Type of Business
:________________________________________________________
Name of Business :________________________________________________________
Name of Owner :________________________________________________________
Mailing Address :________________________________________________________
Mailing City :__________________________ State:________ Zip:____________
State I.D. #:______________________________ Federal I.D. #:____________________
Location of Business: Block #:_________________ Lot (s) #:___________________
Business Street Address:____________________________________________________
Business Phone #:_______________________ Owners Phone #:___________________
Number of Employees:___________________
Do you use or store any hazardous materials in conjunction with your business?________
If yes, please list types:_____________________________________________________
>______________________________________________________________________
Additional Information:____________________________________________________
>______________________________________________________________________
In the event of an emergency please provide us with an emergency telephone number:
____/____/_________, and the name of a contact person__________________________
This information will be forwarded to the local fire department where your business is located.
_______________________________________ ______/______/______
Owner’s Signature Date