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2. Permit Fee: $30
   Annual renewal applied to utility bill: $15
   This form is for Permits that will NOT be connected with DirectLink
4. Note:
   An incomplete form will delay your service start date.
6. Street Address*
   You do not need to enter city, state, or zip code.
8. Previous Address
   Please provide previous West University Address if you held a prior alarm permit. You do not need to enter city, state, or zip code.
10. Alarm Use*

    1. Residential
    2. Commercial
12. First Name*
13. Last Name*
15. Email Address*
16. Home Number
17. Cell Number*
19. Secondary Contact Information (resident)
21. First Name
22. Last Name
24. Email Address
25. Cell Number
27. Commercial Information
29. Property/ Business Name
30. Phone Number
32. Name of Manager or Owner
33. Phone Number
35. Emergency Contact Information : (required for resident/business)
    Other than the resident or business owner/manager, List two individuals who can respond to the alarm site, have access to the site and the code for disarming the alarm.
37. First Name*
38. Last Name*
40. Address1
42. Address2
44. City
45. State
46. Zip
48. Home Number
49. Cell Number *
51. First Name
52. Last Name
54. Address1
56. Address2
58. City
59. State
60. Zip
62. Home Number
63. Cell Number
65. Alarm System Information
67. Types of Signals*

    Select all that apply

    1. Burglar
    2. Panic
    3. Fire
    4. Emergency Medical
69. Installer Company Name
70. Installer Company Phone Number
72. Monitored By*
73. Phone Number*
74. Alarm Panel Brand / Model Number
76. City of West University Place Other Provisions
    City of West University Place Other Provisions

    Please read and acknowledge the City of West University Place Provisions

78. First Name*
79. Last Name*
Leave This Blank:


81. 1. Receive an email copy of this form.
82. Email address

    This field is not part of the form submission.

83. Submit Submit and Print

* indicates a required field