NEW ALARM PERMIT APPLICATION
UPDATE CALL-OUT LIST
Mount Vernon Police Department strives to provide the best service possible. As first
responders, we must know who to contact in case of an after-hours occurrence at your home or
business. Please complete each line on both sides of the application.
PLEASE TYPE OR PRINT LEGIBLY
DATE
CALL OUT ALARM PERMIT FOR: RESIDENCE BUSINESS
OWNER
(LAST) (FIRST) (MIDDLE INITIAL) (DATE OF BIRTH)
HOME
ADDRESS
HOME
PHONE CELL PHONE
EMAIL
ADDRESS________________________________________
BUSINESS
NAME
BUSINESS
ADDRESS
BUSINESS
PHONE _____________________ BUSINESS HOURS
ALARM
COMPANY NAME
(IF APPLICABLE)
ALARM
COMPANY PHONE NUMBER
(IF APPLICABLE)
MOUNT VERNON CITY ALARM PERMIT NUMBER MA-
(IF APPLICABLE)
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X
CALL OUT INFORMATION
Please list names in preferred order of callout. Names listed may be called at any time, must have
access to the building and must be able to respond day or night. All information requested
is required and will be used by the Mount Vernon Police Department
1
st
Call Out
Last Name First Name Middle Initial
Home Phone Work Phone Cell Phone
Home Address Work Address
Date of Birth Driver’s License No. State
2
nd
Call Out
Last Name First Name Middle Initial
Home Phone Work Phone Cell Phone
Home Address Work Address
Date of Birth Driver’s License No. State
3
rd
Call Out
Last Name First Name Middle Initial
Home Phone Work Phone Cell Phone
Home Address Work Address
Date of Birth Driver’s License No. State
PLEASE COMPLETE AND SEND TO THE MOUNT VERNON POLICE DEPARTMENT
You may also email the completed documents to: Burglaralarms@mountvernonwa.gov
If you have any questions contact Sergeant Brent Thompson or the Receptionist at (360) 336-6271
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Declaration
I am aware that my alarm registration is not transferable to another person or to another alarm site.
I am also aware that my alarm registration requires a one-time fee of $10, and that it will expire on
December 31 of this year and must be renewed by submitting an updated application form.
I have written operating instructions for the previously described alarm and have been trained in
proper use of the alarm system.
I am also aware that law enforcement response may be influenced by a variety of factors including,
but not limited to the availability of police units, priority of calls, weather conditions traffic conditions,
emergency conditions, staffing levels, etc.
Comments:
(Signature of applicant)
Fees and Penalties
Application (one-time fee) $10.00
* * * * * * * * *
False alarm penalties (per calendar year):
1-3 false alarms No charge
4, 5 and 6 false alarms $50.00 each
7 and more false alarms $100.00 each
Example: If a user had a false alarm in February of 2019 and two false alarms in March of 2019, the
user would be billed for any additional false alarms that occurred through December 31, 2019.
The user would then “start over” for any false alarm activations occurring in the next calendar year
(January 1, 2020 through December 31, 2020).
Please note additional information in Mount Vernon Municipal Code Chapter 8.36 regarding
alarm use and requirements.
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click to sign
signature
click to edit