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Alarm Users Permit Application

  1. City of Portage 2013 Logo
  2. Department of Public Safety – Police Division
  3. This permit is authorization for an alarm system for the identified location only. Additional sites require additional permits. This permit is not intended to certify operability or effectiveness of the alarm equipment system or any portion thereof. The issuing agency reserves the right to revoke this permit for violations of any state law or ordinance relating to the operation of the alarm system.
  5. EMERGENCY CONTACTS: (Three are required. List in preferred calling order.)
  7. Exit Doors?*
  8. Any Weapons on Premises?*
  9. If "Yes," Select Weapons Type
  11. Alarm Type*
  12. 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.
  13. Leave This Blank:

  14. This field is not part of the form submission.