Burglary and Robbery Alarm Permit

Address(alarm location): REQUIRED

City: REQUIRED

State: REQUIRED

Zip: REQUIRED

Business or Residence Name: REQUIRED

Phone: REQUIRED

Email Address: REQUIRED

Please list below the name and telephone numbers of three persons who are authorized to reset the alarm and check the premises in the even that we are unable to contact you:

Name: REQUIRED

Name: REQUIRED

Name: REQUIRED

Alarm Company Name: REQUIRED

Phone: REQUIRED

Type of Alarm:
(check all boxes that apply)

I agree to comply with the standards in section 7.200 of the Astoria Code.

Owner/User Name: REQUIRED

Signature: REQUIRED
By typing your name, you verify your signature of this form.

Mailing Address: REQUIRED

City: REQUIRED

State: REQUIRED

Zip: REQUIRED