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2. 
3. City of Pasadena, Texas Alarm Permit Application

   For Burglar and/or Holdup Alarm Systems

7. FOR INTERNAL USE ONLY

9. Permit #:
10. Expiration Date:
    Expiration Date:

14. Business Application/Renewal Fee: $30.00 Residential Application/Renewal Fee: $15.00 Check or money order payable to: City of Pasadena

    1149 Ellsworth Dr. Pasadena, TX 77506 Attn: Alarm Permit 

15. 1. Residential
    2. New Permit
    3. update

    1. Business
    2. Renewal
    3. Cancel
19. Alarm Location Information:
21. Address of Alarm (Where alarm Is located)*
22. Suite, Apartment#
24. City*
25. State*
26. Zip Code*
28. Name of resident or Business*
29. Type: Burglary/Robbery/Emergency/Other*
31. Phone Number*
32. Name of Alarm Company (Address & Phone #)*
34. Names of Residents at Alarm Site If Apartment or Residence*
36. 1. Permit HoIder Contact Information: Person responsible for notification, responding to alarm site within 1 hour, grant access, maintenance, operation of alarm system and payments.
38. Last Name*
39. First Name*
40. lnitial *
41. Driver License#*
43. Date of Birth*
44. Street#, Street Name *
45. Suite, Apartment#
46. City*
48. State*
49. Zip Code*
50. Home Phone#
51. Business Phone#
53. Cell Phone#*
54. Email Address*
56. 2. First Local Emergency Contact: Person to receive notification, respond to alarm site within 1 hour and grant access.
58. Last Name*
59. First Name*
60. Initial*
61. Driver License #*
63. Street#, Street Name*
64. Suite, Apartment #
65. City*
66. State*
68. Zip Code*
69. Home Phone#
70. Business Phone #
71. Cell Phone#*
73. 3. Second Local Emergency Contact: Person to receive notification, respond to alarm site within 1 hour and grant access
75. Last Name*
76. First Name*
77. Initial*
78. Driver License #*
80. Street #, Street Name*
81. Suite, Apartment #
82. City*
83. State*
85. Zip Code*
86. Home Phone#
87. Business Phone#
88. Cell Phone#*

92. I have read the completed application and know the same is true and correct and hereby agree that If a permit is issued, I will comply with all provisions of Pasadena City ordinance ch.30. I accept responsibility for payment of all fees and fines that may result from the operations of the alarm system servicing the above premises.

94. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
96. Electronic Signature*
97. Date:*
    Date:

99. 1149 Ellsworth Dr. Pasadena, TX 77506 (713-475-5575)

Leave This Blank:


101. 1. Receive an email copy of this form.
102. Email address

     This field is not part of the form submission.

103. Submit Submit and Print

* indicates a required field