[PDF] CONFIDENTIAL INFORMATION* CITY OF ELMHURST - ALARM

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*CONFIDENTIAL INFORMATION* CITY OF ELMHURST - ALARM PERMIT RECORD *POLICE & FIRE*Revised 07/2017

APPLICATION FEE: (Initial Fee $25)_____ (Renewal Fee $15)______ DATE OF APPLICATION: APPLICANT LAST NAME: FIRST NAME:

ALARM STREET ADDRESS:

CITY: ELMHURST STATE: ILLINOIS ZIP CODE: 60126 PHONE NUMBER:

EMAIL:

IF THIS IS AN ALARM FOR A BUSINESS, PLEASE PROVIDE THE FOLLOWING INFORMATION:

BUSINESS OWNER'S NAME:

BUSINESS NAME:

BUSINESS ADDRESS:

BUSINESS PHONE NUMBER:

- ALARM INFORMATION _____ Fire Alarm _____ Police Alarm

ALARM INSTALLED BY:

PHONE NUMBER:

ALARM MONITORED BY: PHONE NUMBER:

ALARM SERVICED BY:

PHONE NUMBER:

CHECK ALL OF THE FOLLOWING THAT APPLY TO THE TYPE OF ALARM INSTALLED:

ANSWERING SERVICE: AUTO/HOLD UP ALARM: MANUAL FIRE: AUDIBLE: CENTRAL STATION: MOTION:

AUTO BURGLAR ALARM: COMBINATION: POLICE ALARM: AUTO FIRE: DIRECT CONNECT: SILENT: AUTO/DIALING DEVICE: LOCAL PREMISE ONLY: SPRINKLER:

OTHER (EXPLAIN):

CONTACT PERSON (MINIMUM OF TWO NAMES REQUIRED)

PLEASE PROVIDE THE NAMES OF PERSONS WHO CAN BE CONTACTED AT ANY TIME, DAY OR NIGHT, WHO ARE AUTHORIZED TO RESPOND TO AN ALARM SIGNAL AND WHO CAN OPEN THE SYSTEM. PLEASE PROVIDE AT

LEAST TWO NAMES.

NAME:

PHONE NUMBER:

NAME:

PHONE NUMBER:

NAME: PHONE NUMBER:

_____________________________

SIGNATURE OF APPLICANT DATE

MAKE YOUR CHECK PAYABLE TO: CITY OF ELMHURST

MAIL APPLICATION TO: CITY CLERK 209 N. YORK ELMHURST, IL 60126

FOR OFFICE USE ONLY

DATE RECEIVED: POLICE FIRE PERMIT EXPIRES: MAILED TO APPLICANT: ___________________ APPLICANT RECEIPTquotesdbs_dbs8.pdfusesText_14

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