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Alarm Permit Application
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ALARM PERMIT APPLICATION
Date
*
ALARM LOCATION
Resident or Business name
*
Type
*
Residential
Business
Address
*
Apt / Suite
City
*
State
*
Zip
*
Phone
*
RESPONSIBLE PERSON
Responsible Person
*
Drivers License No.
*
DL State
*
Address
*
City
*
State
*
Zip
*
Phone
*
Cell
*
Email Address
*
Purpose
Duress / Robbery
Medical Response
Police Response
Fire Response
Other
Purpose Other
ALARM INSTALLATION COMPANY
If this is a new alarm you must complete this section. Skip this section if the alarm is pre-esisting and you do not know who installed the alarm.
Installed by
*
Installed on
*
Address
*
City
*
State
*
Zip
*
Phone (24 Hour)
*
State Permit No.
*
Madison License No.
*
ALARM MONITORING COMPANY
Alarm Rings To
*
N/A
Alarm Company
Company Name
*
Address
*
City
*
State
*
Zip
*
Phone (24 Hour)
*
Multi-tenant
Yes
No
Number of tenants
2
3
4
5
6
7
8
9 or more
EMERGENCY CONTACTS
If an emergency occurs, list in order of contact who you want notified. Ti will be the responsibility of the home or business owner to notify the Madison Police Department of any changes to this list.
Contact One
Name
*
Address
*
State
*
Zip
*
Phone
*
Cell
*
Contact Two
Name
*
Address
*
State
*
Zip
*
Phone
*
Cell
*
Contact Three
Name
*
Address
*
State
*
Zip
*
Phone
*
Cell
*
SPECIAL CIRCUMSTANCE
Please describe any special circumstances(s) that officers should be aware of when responding to your alarm. For instance, vicious, dangerous or exotic animals, mentally, physically or emotionally impaired individuals, or locked closets or rooms.
List Circumstance(s)
Please fill in a complete and accurate narrative.
By submiting this application the registrant certifies that he or she has read the
Alarm Ordinance
and rules and regulations regarding the use and operation of central alarm systems within the City of Madison and that he or she agrees to be bound by the terms and conditions stated therein and any amendments hereinafter made thereto.
Created by the Law Enforcement Technology Coordinator
* indicates required fields.
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