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Burglar/Fire Alarm Application
Attention
If you wish to file the application through the mail, please click
HERE
and mail the completed form to: Orem Department of Public Safety, Attn: C.S.S., 95 E. Center Street, Orem, Utah 84057, or fax it to (801) 229-7242
Fire Alarm Application
Business Name or Resident
Last Name
First Name
M.I.
Date of Birth
Required!
Required!
Required!
Address of Alarm Location: (Include coordinates)
Unit #
Zip Code
Required!
1
2
3
4
5
6
7
8
9
10
Required!
Mailing Address (If different from alarm location)
Residential Phone #
Business Phone #
Required!
Required!
If a business – name of owner (Individual responsible for payment of alarm fees)
Required!
Alarm installer / Service Representative (Company)
Address
Phone
Required!
Required!
Required!
Monitoring Company
Address
Phone
Required!
Required!
Required!
Responsible Alarm Contacts (Three required)
Full Name
Address
DOB
Phone#'s
Required!
Required!
Required!
Required!
Full Name
Address
DOB
Phone#'s
Required!
Required!
Required!
Required!
Full Name
Address
DOB
Phone#'s
Required!
Required!
Required!
Required!
Please Read Carefully before Submitting the Application
List above the responsible persons who (1) Can respond to the alarm after notification, (2) Are knowledgeable in the basic operation of the alarm system, and (3) Are authorized and able to gain entry and secure the premise if required.
As the permit applicant, I have read the completed application and represent the same to be true and correct. I hereby agree that if a permit is issued, I will comply with all the provisions of the City ordinance and applicable State laws. I accept responsibility for all fees or fines that may result from the operation of the alarm system serving the above premises.
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