PLEASE TYPE OR
PRINT LEGIBLY
BUSINESS OR RESIDENTIAL ALARM PERMIT
CITY OF HOPEWELL FIRE DEPARTMENT
200 S. HOPEWELL STREET
HOPEWELL, VIRGINIA 23860
□ COMMERCIAL
A
SEPARATE PERMIT MUST BE COMPLETED
FOR EACH LOCATION
BUSINESS OR RESIDENT NAME & LOCATION OF PREMISES (TENANT NAME IF APPLlCABLE)
BUSINESS OR RESIDENT NAME (LAST, FIRST, M.I.) BUSINESS HOURS WEEKDAYS SATURDAY SUNDAY
HOME ADDRESS (STREET#) (STREET NAME) BUSINESS ADDRESS (STREET#) (STREET NAME)
HOME PHONE NUMBER BUSINESS PHONE NUMBER
CONTACT PERSONS OTHER THAN TENANT, BY ORDER OF PREFERENCE
LIST AT LEAST TWO PERSONS WHO ARE AUTHORIZED TO SECURE THE PREMISES IN THE EVENT OF AN ALARM ACTIVATION
NAME(LAST) {FIRST) (M.I.) HOME PHONE# CELL OR PAGER#
ADDRESS (STREET#) (STREET NAME) SUITE/APT# BUSINESS PHONE#
NAME(LAST) (FIRST) (M.I.) HOME PHONE# CELL OR PAGER#
ADDRESS (STREET#) (STREET NAME) SUITE/APT# BUSINESS PHONE #
NAME (LAST] (FIRST) (M.I.) HOME PHONE# CELL OR PAGER#
ADDRESS (STREET#) (STREET NAME) SUITE/APT# BUSINESS PHONE#
OWNER(S) OF PREMISES (IF DIFFERENT FROM TENANT)
NAME(LAST) (FIRST) (M.I.) HOME# BUSINESS# CELL OR PAGER#
ADDRESS (STREET#) (STREET NAME) SUITE/APT# STATE
MAILING ADDRESS FOR CORRESPONDENCE (IF DIFFERENT FROM LOCATION)
ADDRESS (STREET#) (STREET NAME) SUITE/APT# STATE ZIP
ACTIVATION TYPE (CHECK ALL THAT APPLY) ALARM SIGNAL
□ SECURITY
□ MOTION □ HOLD-UP □ OTHER
□ AUDIBLE □ SILENT
□ FIRE
□ SPRINKLER □ PULLSTATION □ DETECTORS
IF MONITORED. BY WHAT ALARM COMPANY:
ADDRESS· BUSINESS PHONE#:
ALARM SERVICE COMPANY, IF DIFFERENT FROM ABOVE:
ADDRESS: BUSINESS PHONE#:
SAFE-INFORMATION IS THERE A SAFE ON THE PREMISES? □ YES □ NO IF YES, GIVE EXACT LOCATION IN BUILDING
O'THER PERTINENT INFORMATION ABOUT THE MERCHANT/ALARM SYSTEM:
IF THIS FORM IS BEING USED FOR AN ALARM PERMIT APPLICATION, READ AND SIGN BELOW.
BY SUBMISSION OF THIS APPLICATION ONLINE OR IN PAPER FORMAT, I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT; AND THAT I
HAVE REVIEWED AND WILL ABIDE BY ALL PROVISIONS OF CITY CODE CHAPTER 15 - ALARM SYSTEMS. Chapter 15 article IV
APPLICANT SIGNATURE Date
(ONLINE APPLICANTS PLEASE TYPE IN NAME.)
WHITE·POLICE RECORDS COPY YELLOW · ALARM COMPANY COPY GOLDENROD- COMMUNICATIONS PINK- PERMIT HOLDER COPY
