DAYTON POLICE DEPARTMENT
Alarm Permit Application
FOR OFFICE USE ONLY
PERMIT NUMBER
DATE ISSUED
/
/
DATE RENEWED
/
/
TEMPORARY PERMIT
ORIGINAL PERMIT
Permit Fee: $10.00
cash
REVOKE PERMIT
Check
RENEW PERMIT
Money Order
1. Applicant Information:
Full Name of Business/ Occupant / Resident
Alarm Site Address
Apt/Suite
Mailing Address (if different from Site Address)
Apt/Suite
City, State Zip
2. Alarm Site:
Residential
Commercial
Other
own
Rent/ Lease
3. Business Hours:
AM/PM to
AM/PM
4. Alarm Type:
Burglary
Robbery
Monitored
Audible Only
5. Alarm Monitoring Company:
Name/ Address
Phone
6. Building Owner. If different from Resident/ Occupant/Tenant please list name, mailing
address
and phone number of owner.
7. Hazards: Please list any special conditions or hazards at the Alarm Site
(Dog, Electric Fence, etc)
(Please initial the following sentences indicating your understanding. Failing to do so will result in a delay in the process.)
I have read the competed application and represent the same to be true and coned.
I have received a notice of the City of Dayton Ordinance 29383-97 for Alarm Systems.
I acknowledge the $10.00 Alarm Permit fee is
non-refundable,.
I accept responsibility for payment of all fees or fines that may result from the operation on the alarm system
serving the above alarm site I will surrender this permit if I transfer ownership of the alarm site property.
Permit Applicant Signature
(Required)
Date