Residential Security Monitoring System
Please submit one form annually per residence. If space on form is not applicable, please indicate by typing N/A.
Property Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Property Owner / Occupant
*
First Name
Last Name
Property Owner's / Occupant's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Property Owner's Email
*
example@example.com
Secondary Contact Person
*
First Name
Last Name
Secondary Contact Person's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Contact Person's Email
*
example@example.com
Is the alarm monitored by an alarm company?
*
Yes
No
Name of Alarm Company
*
Alarm Company Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Certification: I hereby certify that I have read the completed application and know the same is true and correct and hereby agree that a permit is issued. I will comply with all provisions of the City of Lacy Lakeview Ordinance, Chapter 116 and applicable state laws. I accept responsibility for all fines that my result from the operation of the alarm system serving the above premesis.
*
Yes
No
Signature
*
Submit
Should be Empty: