City of Pompano Beach
Department of Development Services
Building Inspections Division
100 W. Atlantic Blvd Pompano Beach, FL 33060
Application for Alarm Registration
Phone: 954.786.4670 Fax: 954.786.4677
Registration #
Date
Applicant's Property to be served by alarm: Legal Property Owner/ Authorized Agent:
__________________________________________ __________________________________________
Applicant's Name Property Owner's Name:
__________________________________________ __________________________________________
Applicant's Phone Property Owner's Phone:
__________________________________________ __________________________________________
Applicant's E-mail Address Property Owner's E-mail Address
__________________________________________ __________________________________________
Applicant's Address (to be served by alarm) Unit # Property Owner's Mailing Address (Street Address / Unit)
__________________________________________ __________________________________________
Applicant's Mailing Address (if different from above): Property Owner's Mailing Address (City/ State/ Zip):
__________________________________________ Type of alarm: □ Burglar alarm □ Fire Alarm
Applicant's Mailing Address (City/ State/ Zip)
Alarm Monitoring: Check the following :
□ Wireless □ Hardwired
__________________________________________ __________________________________________
Alarm monitoring company name: Alarm company phone
Provide signatures of alarm user, owner of property or authorized agent as per Section 102.05 A (6):
________________________________________ _____________________________________________
Signature of Alarm User Signature of Legal Property Owner/ Authorized Agent
________________________________________ _____________________________________________
Print Name of Alarm User Print Name of Legal Property Owner/ Authorized Agent
_____________________________________________
Property Owner Phone Number
NOTE: INFORMATION CONTAINED ON THIS APPLICATION MUST BE COMPLETE, LEGIBLE, AND
KEPT CURRENT BY REGISTRATION HOLDER. PLEASE NOTIFY ALARM REGISTRATION
DEPARTMENT OF ANY CHANGES AT (954) 786-5558 or (954) 786-5311.
(SEE INSTRUCTIONS AND INFORMATION ON REVERSE SIDE)
G:\Zoning 2009\Forms and Sample documents\Website Documents\Building\Forms\alarms.pdf Modified:3.23.2015