CITY OF DAYTONA BEACH SHORES 3050 South Atlantic Avenue Daytona Beach Shores, Florida 32118 (386) 763-5321 “Life is Better Here” NEW

Issue Date:______________ Serial No _____________

APPLICATION FOR ALARM PERMIT CITY CODE OF ORDINANCES, CHAPTER 11 ½, SECTION 3 1.

ALARM USERNAME_______________________________________________________________ ADDRESS: ________________________________________________________________________ TELEPHONE_______________________________________________________________________

2. BUSINESS NAME___________________________________________________________________ ADDRESS: ________________________________________________________________________ TELEPHONE______________________________ EMERGENCY CONTACT PERSON:___________________________PHONE:_________________ 3.

OWNER OR MGR IN CHARGE OF PROPERTY:_________________________________________ ADDRESS:________________________________________________________________________ TELEPHONE:______________________________________________________________________

4.

NAME OF INSTALLING COMPANY: __________________________________________________ ADDRESS: _________________________________________________________________________ TELEPHONE:_______________________________________________________________________

5.

NAME OF MONITORING COMPANY: _________________________________________________ ADDRESS: _________________________________________________________________________ TELEPHONE: _______________________________________________________________________

6.

COPY OF ALARM ORDINANCE PROVIDED TO APPLICANT? _______YES

7.

SIGNATURE OF APPLICANT I hereby certify that to the best of my knowledge all of the information provided on this application is correct:

______NO

X___________________________________________________________Date __________________

***New $20.00 check or cash Please make checks payable to the City of Daytona Beach Shores