Alarm User Registration Form

Please select one:
Residence Business: Lending Institution Business: Convenience Store Government: City Government: County Government: State Government: Federal

Registration Information

Please complete all information requested. Enter "N/A" in any space which does not apply.

Business/Resident Name

Alarm Location (Address)

Suite/Apt. No.

Clearwater, FL Select ZIP 33755 33756 33757 33758 33759 33760 33761 33762 33763 33764 33765 33766 33767

Business Telephone
- -

Home Telephone
- -

FAX Number
- -

Mailing Address

City

State

ZIP

It is not necessary to provide the building permit number and the date of final inspection if your alarm system became operational before October 1, 1990 or if this application is for a residence. All business alarm systems installed after October 1, 1990 are required to obtain a building permit and final inspection by the City of Clearwater Building Department.

Date Alarm System Became Operational
/ /

City of Clearwater Building Permit No. (Not required for Residence)

Date of Final Inspection By Building Department (Not required for Residence)
/ /

Type of Alarm (Check all that apply)
Intrusion
Holdup
Panic

Servicing Alarm Company Name

Address

Telephone
- -

Monitoring Alarm Company Name

Address

Telephone
- -

City of Clearwater Ordinance Section 5.61 requires all businesses and residences with security alarm systems to possess a valid alarm permit. Violation of this section shall be punished by a fine not exceeding five hundred dollars ($500.00) for each day the alarm system is operated without a valid alarm permit.

Emergency Notifications

List full names and personal information of individuals with keys to respond in case of emergency. List yourself first.

1. Name
   
   Owner Manager Employee
   Other :

2. Address
   

   Telephone
   - -

   Race
   White Black Oriental Indian Hispanic

   Sex
   Male
   Female

   Birthdate
   / /

3. Name
   
   Owner Manager Employee
   Other :

4. Address
   

   Telephone
   - -

   Race
   White Black Oriental Indian Hispanic

   Sex
   Male
   Female

   Birthdate
   / /

5. Name
   
   Owner Manager Employee
   Other :

6. Address
   

   Telephone
   - -

   Race
   White Black Oriental Indian Hispanic

   Sex
   Male
   Female

   Birthdate
   / /

This information will only be used by Alarm Unit personnel at Clearwater Police Department to insure proper identification of people notified in the case of an active alarm. Birthdates must be supplied. Incomplete forms will not be processed. If you require assistance completing this registration form, contact the Alarm Unit Monday through Friday, 8:30 AM until 4:30 PM at (727) 562-4242, and 562-4449 or 562-4450 for Alarms.