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APPLICATION FOR ALARM PERMIT
PFLUGERVILLE POLICE DEPARTMENT 1611 E. PFENNIG LN.,
P.O. BOX 679 PFLUGERVILLE, TEXAS 78691-0679 Fax: Fax: 512-670-5501
This form may only be submitted from Firefox or Google Chrome. If you fill out in IE, please fax or mail.
(For Staff Use Only)
Permit#
Issue Date:
Application Date:
Approved by:
Expiration Date:
The permittee must notify the Chief of Police of any changes of information contained herein within 5 days of the change.
The permit is not assignable or transferable to another person.
The permit is valid to December 31st of each year.
The application may be denied or revoked if there is a false statement on the application, the Permittee has violated any provision of the Alarm
Permit Ordinance, or the Permittee is delinquent in payment of fees for False Alarm Notifications assessed under Section 4.02 of the Alarm
Permit Ordinance. A permit may be denied for Alarms or Alarm Systems not in compliance with: Article 5.33A, Section 6(a)(2) of the Texas
Insurance Code.
 False Alarm Fee is $25 subject to conditions indicated in the Alarm Permit Ordinance.
 The Chief may cancel an alarm permit for non-renewal after providing at least 30 days’ notice.
 The Pflugerville Police Department will not respond to Alarm Notifications if Permittee fails to pay False Alarm Fees or if a permit is not approved
for that system.
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Alarm Information
Location / Alarm Site:
Alarm Company:
Date Installed:
(Address where alarm is located. If business include business name)
Permittee Information
Name:
Address:
Home Ph#:
E-mail:
Admin Ph#:
Purpose: ☐ Burglary
☐ Fire
(If business, put business name)
Type:
(Residential, Commercial, Banking Institute)
Monitoring Site Ph#:
☐ Robbery ☐ Audible Knox Box:
☐ Medical
☐
Silent
(See Attached)
Contact Name:
(If business, put name of contact representative)
Work Ph#:
Cell Ph#:
Would you like to sign up for renewal notification? If yes, check all that apply: ☐ E-Mail ☐ Text Message
Contact Information - List two additional persons authorized by the permittee to receive, and who have agreed to receive,
notification that they must come to the Alarm Site within 30 minutes of receiving the notification from responding emergency
personnel.
Name:
Address:
Home Ph#:
E-mail:
Name:
Address:
Home Ph#:
E-mail:
Work Ph#:
Cell Ph#:
Work Ph#:
Cell Ph#:
Submit
REV: 04/15
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