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SECURITY/FIRE ALARM LICENSE APPLICATION City of Whitefish PO Box 158 Whitefish, MT 59937 Phone: [PHONE REDACTED] Fax: [PHONE REDACTED] License is valid for one year January 1st through December 31st City Ordinance requires that all Security/Fire Alarm businesses operating within the Whitefish City limits to obtain a license. Please complete the required information below, mark the applicable license fee, and return this form with the applicable fee to the address shown above. Security/Fire Alarm License Fee: $100/one-time fee City of Whitefish Business License: $30/yearly renewal fee Montana Fire Alarm Certificate of Registration Number: Federal Identification Number: Legal Name of Business Entity: All trade names or business names used by the business: APPLICANT ASSUMED NAME OR d/b/a NAME (doing business as) PHYSICAL BUSINESS LOCATION (no post office boxes) CITY STATE ZIP CODE COUNTY TELEPHONE NO. FAX NO. E-MAIL ADDRESS FOR NOTIFICATION PURPOSES WEBSITE ADDRESS (optional) MAILING ADDRESS (The mailing address must be the same for a firm’s certificate of registration and all branch offices) CITY STATE ZIP CODE OWNER/MANAGER CONTACT PHONE EMERGECY CONTACT NAME & PHONE ---PAGE BREAK--- Monitoring Information Please print or type. Any fraudulent representation on this form may be cause for denial, suspension, or revo- cation of the license. 1. Name of monitoring firm Montana Fire Alarm Certificate of Registration No. 2. Specific business location where monitoring will take place: This application is made subject to all the terms and conditions of the ordinances of the City of Whitefish. I understand the license issued hereunder is NOT TRANSFERRABLE and that the information I have supplied is correct t o the best of my knowledge. Signature Date Title LOCATION 1 Address: Telephone: / City: State: Zip code: County: The monitoring service at this location is in compliance with adopted NFPA 72. LOCATION 2 Address: Telephone: / City: State: Zip Code: County: The monitoring service at this location is in compliance with adopted NFPA 72. ADDITIONAL AUTHORIZED SIGNATURES: List all persons that you authorize, on behalf of your firm, to sign offi- cial documents submitted to this office. (Examples: change of firm’s business or mailing address, change of corporate officer, employment or termination of licenses.) PRINTED NAME SIGNATURE TITLE DATE PRINTED NAME SIGNATURE TITLE DATE CITY STAFF USE ONLY————— Application Date: Amount Paid: Rect Disposition: Approved: License No.: Date: Denied: Reason: Date: Appeal Filed (date): Council Action: Date: