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Type Full Name :
Sign With Hand
Is the Alarm Site equipped or nonequipped for duress alarm?
Please attach any necessary documents below.
Permit holder and responsible for proper maintenance and operation of the alarm system.
City, State, ZIP
Business Owner Information
Owner Cell #
Building Owner Phone #
Number of Animals
Owner Phone #
Any animals in residence or business?
Note: Alarm must shut off or reset within 15 minutes.
Company Name (if applicable)
Building Owner Cell #
Building Owner Name
Special Conditions or Hazards
Burglar or Fire Alarm?
Date of Installation, Conversion, or Takeover
Information/hazards for police officers or fire personnel
Purpose (if other)
2nd Phone # (Work or Other)
City, State, ZIP
Type of Animals
Alarm Types (Check all that apply)
Provide information of the business monitoring the alarm system if different from the installing alarm company.
Name and phone number of AT LEAST ONE person who are familiar with system and have password and/or keys to be contacted in case of alarm and/or malfunction of alarm system. They should be able to respond in a reasonable amount of time.
Provide information of the alarm company performing the alarm system installation, conversion or alarm system takeover and responsible for providing repair service to the alarm system.
I hereby certify that:
a set of written operating instructions for the alarm system, including written guidelines on how to avoid false alarms, has been left with the applicant.
The alarm business has trained the applicant in the proper use of the alarm system, including instructions on how to avoid false alarms.
Any false statement of a material matter made by an applicant for the purpose of obtaining an alarm permit shall be sufficient cause for refusal to issue a permit.
An alarm permit cannot be transferred to another person.
An alarm user shall inform the alarm administrator of any change that alters any information listed on the permit application within five business days.
Information contained in permit applications shall be held in confidence by all employees or representatives of the municipality with access to such information.
Emergency Contact Details
Resides in Town
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