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Fire Alarm Permit Registration Form

2. Village of Skokie
   Fire Department

   Fire Department

3. 

5. Fire Permit Registration Form
   Please review the information for accuracy.

   Please review the information for accuracy.

7. 1. Alarmed Location

9. Business Name:*

11. Address:*

13. City:*

14. State:*

15. Zip:*

17. Phone Number:*

18. Email:*

20. 2. Responsible Party

22. Name:*

23. Phone Number 1:

25. Address:*

27. City, State, Zip*

28. Email:*

30. 3. Contact Names

32. Contact 1:*

    Name

33. Phone Number:*

35. Address:

37. City, State, Zip:

38. Email:

40. Contact 2:*

    Name

41. Phone Number:*

43. Address:

45. City, State, Zip:

46. Email:

48. 4. Monitored by

50. Company Name:*

51. Phone Number:*

53. Address:

55. City, State, Zip:

56. Email:

58. 5. Serviced by

60. Company name:*

61. Phone Number:*

63. Address:

65. City, State, Zip:

66. Email:

68. Please indicate the fee type:*

    1. $25.00 Original Alarm Permit Fee

    1. $20.00 Annual Alarm Permit Fee

    1. $50.00 Alarm Permit Reinstatement Fee

70. Payments should be sent to:
    Village of Skokie 5127 Oakton St. Skokie IL, 60077

    Village of Skokie 5127 Oakton St. Skokie IL, 60077

71. Date of Submission:*

Leave This Blank:


73. 1. Receive an email copy of this form.
74. Email address

    This field is not part of the form submission.

75. Submit Submit and Print

* indicates a required field