Alarm Permit Application Form printable pdf download

PLEASE PRINT

PHONE: 817-392-1300

THE APPLICATION WILL BE

CITY OF FORT WORTH

RETURNED IF NOT

Office hours:

ALARM PERMIT APPLICATION

FILLED OUT COMPLETELY.

Monday through Friday 8 a.m. to 5 p.m.

FOR ONE ALARM SYSTEM

PERMIT FEE:

$50 RESIDENCE (including individual apartments)

$50 COMMERCIAL

PLEASE READ BEFORE FILLING OUT APPLICATION:

1. PERMIT HOLDER-We must have the name, address and telephone numbers (home and business) of the PERSON who will be responsible for the alarm

system. A COMPANY NAME IS NOT ACCEPTABLE.

2. Signature of applicant/permit holder must be the signature of the person listed as permit holder.

3. Please list all zip codes and area codes.

4. Application must include check or money order made out to City of Fort Worth, Texas.

(Note: Payments made by Credit or Debit Cards can be made online at )

5. No permit fee shall be required for a permit obtained for an alarm system at a one-family dwelling when the alarm site is determined by the Chief or

authorized designee to be occupied by a low income family. Proof of low income and number in household required.

ALARM LOCATION INFORMATION:

NAME (Business Name OR Resident Name)

ALARM LOCATION ADDRESS

Zip __________ _

MAILING ADDRESS (If Different)

____

CITY

STATE________________ ZIP ________________________

PERMIT HOLDER INFORMATION (PERSON/USER RESPONSIBLE FOR ALARM SYSTEM):

DRIVER’S LICENSE #

NAME

PHONE # HOME

PHONE # WORK

EMAIL ADDRESS

PERMIT STATUS

New Permit

PERMIT TYPE:

COMMERCIAL ($50 Permit Fee)

RESIDENCE ($50 Permit Fee)

GOVERNMENT (City/County) (no Permit Fee required)

LOW INCOME (no permit fee required; See #5 above))

INDIVIDUAL APARTMENT ($50 Permit Fee)

ALARM COMPANY NAME:

Credit Card Billing Address: ___________________________________________________________________________________________

Payment Amount: $ ________________________________________ Permit Number (if issued) ___________________________________

Payment Method:

MASTERCARD

VISA

DISCOVER

AMERICAN EXPRESS

*For your protection – Do not e-Mail credit card information.

Card Number: _______________________________Expiration Date: __________________________CVS Code: _______________________

Cardholder’s Name: __________________________________________________________________________________________________

Signature: __________________________________________________________________________________________________________

SUBMIT A SEPARATE PERMIT APPLICATION (AND FEE) FOR EACH SYSTEM. PERMIT IS VALID FOR ONE YEAR FROM DATE OF ISSUE.

OFFICE

DATE RECEIVED

PERMIT NUMBER

EXPIRATION DATE

USE

ONLY

I have carefully read the completed application and know the same is true and correct and hereby agree that if a permit is issued, I will comply with all provisions of

Chapter 12 of the Code of the City of Fort Worth and applicable state laws. I accept responsibility for payment of all fees and fines that may result from the operation

of the alarm system described above.

Date

Signature

Send completed application and check to:

CITY OF FORT WORTH

PLANNING AND DEVELOPMENT DEPARTMENT • ALARM UNIT

Please contact our office for alarm

1000 THROCKMORTON STREET • FORT WORTH, TEXAS 76102

systems operated by a state or federal

Revised

DevAlarms@fortworthtexas.gov

governmental entity.