Burglary & Robbery Alarm Permit

Location

Alarm Location Street Address:  City, State Zip:  Business or Residence Name:  Phone:  Email: 

Alternate Contacts

Below, list the name and telephone number of three persons who are authorized to reset the alarm and check the premises in the event that we are unable to contact you:

1. Name:  Phone:
2. Name:  Phone:
3. Name:  Phone:

Alarm Information

Alarm Company Name:  Phone: 

Type of Alarm (check all boxes that apply):

Agreement

I agree to comply with the standards in Section 7.200 of the Astoria City Code, as confirmed by my signature below.

Owner/User Name:   Date:  Signature (Full Name): 
By typing your name, you verify your signature of this form. 
Mailing Address:  City, State Zip:  Phone:  Email: