QS.00 a“ FEES50.66-— TOWNSHIP OF GALLOWAY CLERK'S OFFICE 300 B. JIMMIB LEEDS ROAD GALLOWAY, NEW JERSEY 08205 609-652-3700 EXT 237 = Date: sk)o APPLICATION FOR MERCANTILE LICENSE oO AND FIRE PREVENTION INSPECTION ‘Home Phone: a> Business Phone: _ E-Mail Address: _ ASSCAFE O ConCAST NET Name of Owner: Ona) + La Permanent Home Address: Trade Name of Business:__Aris_ Cage” Business Address: (2 ‘Le Corporation ot Partnership, please list Neme and Address of Each Person Owning 10% or more: aa “Name & Address of Corporation Officers & Titles & Registered Agent Lett Sore __ ee woes TL 1204 toca: — oe ‘The undersigned does hereby certify thet the statements above gi knowledge, and that I will comply with all law-fal f, Representative Coouniny nh! 25265 Owner, Mailing address tormevanste (96. S$ FEEEEEEE EEE EEE EHEEE ELE EEE HEGEL HEE EEE EEE EEEEEE EEE EEE rt ”MERCANTILE APPROVAL CHECKLIST. yo Name of Business: vo) 5 Date Received: 4 05 //; Address of Business: Previous Use / Name of Business: Ae a's Phone #, New Construction / Business ~ please give application to Beth MeCann Approved: iO Issuedom, Denied: Reason for Denial: Existing Business / New Ownership please give form to Ron Garbutt Zoning Official Approved: Denied: Reasons for Denial or Conditions of Approval Fire Inspector Approved: Denied: Reasons for Denial or Conditions of Approval SCHEDULED INSPECTION DATE:. Initials Zoning Official Initials Fee (Renewal Only) Fire Inspection Fire Prevention InspectionRECEIPT - ose no. 860174 RECEIVED FKOM x ‘ ‘ADDRESS Ss FoR Al ioe = oeTOWNSHIP OF GALLOWAY POLICE DEPARTMENT ~ ~"300E. JIMMIE LEEDS ROAD, GALLOWAY, NJ. 08205 uma ane {609) 6523705 FAX: (609) 652-5710 Galloway Township Properiy Registration Form (Please fi in atl known information) roptewsnone: “Thc, Caiend ® Linon Souslieeowermaages ech NERS Steps” (Ke Cape Pron LAYER oe 5 [5|00. raids: N95 So. Nel Nite foo, Gast Tae - Property Type umm Type (ere ceckone (ease checks epeotats} Se Dessert Clowoin ere Cl medicat Saw Emergency Contact List (Aminkmam of three (3) local contacts must be sted) Name: ee Lan Sou toons: Fenn bette Ate a ny: Gee oe sete NS np cote: ‘nD GIR vos, —® name Bein) Pweg feiatonship:_ Flies ity emannr) AU Cena vane Mw Overt - Ackiress cm Lame Gi, Doug sn