Application For Alarm Permit Form - Huntington Beach Police Department

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Huntington Beach Police Department
Application for Alarm Permit
2000 Main Street, Huntington Beach Ca. 92648
714-960-8805
Fax 714-536-2912
CN
For Office Use Only
*** PLEASE RETURN WITHIN 7 DAYS***
______________
Permit Number:
Date Sent
_______
_______________
Renewal Date:
Is this location a Business or Residence? ___________________
Business License No. (if applicable): _____________________
Name (
) ______________________________________________________________
of Business or Residence
Last
First
Middle
Location Address:
Unit _
Zip Code
_
Location Phone: ______________________________
Cell Phone: _________________________________
To obtain or renew an alarm permit complete this application. If you have any questions contact the Alarm Office. If you are renewing
and the information remains the same, check the “No Changes” box, sign, date and return with payment.
New _____
Renewal _____
Information Changes Only _____
No Changes _____
Mailing Address (If different from above)
Name :____________________________________________________ Attn: __________________________
Address : __________________________________________________________________________________
City: _______________________________________________________ State: ______ Zip: ______________
: ____________________________________
: _______________________
Name Emergency Contact #1
Phone
: ____________________________________
: ________________________
Name Emergency Contact #2
Phone
: ____________________________________
: ________________________
Name Emergency Contact #3
Phone
Owners Name: _______________________________________________Phone: ________________________
Alarm Company: _
_________________ Phone: ________________________
Signature: __________________________________________________ Date: __________________________
Fee: $36.00
For Office Use Only
Return Form and Check
Payable to the City of Huntington Beach to:
Approved by: ____________ Date: _______________
Alarm Office
Huntington Beach Police Department
____________________________________________
2000 Main St.
Huntington Beach, Ca. 92648
Payments are not transferrable or refundable
PDAlarmPermitApp

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