Date

Approved
Mall Mgt
Signature

PERMIT TO WORK BEFORE / AFTER MALL BUSINESS HOURS

NOTE: Permit must be filed at least 72 hours prior to requested date of work
There “must” be a separate Permit for Saturdays and Sundays.

Date Requested: Time: to Total Hours:___

Start Finish

Nature of
Work:
Space No.: Project Mgr.
Tenant Name: Office Telephone:
Contractor Office Facsimile:
Address: Cellular/ Pager:
Main Office Tel. Superintendent:
Main Office Fax: Field Telephone:
Cellular / Pager:
Number of People that will be working:

DO NOT WRITE INSIDE THIS BOX. FOR OFFICE USE ONLY

Request Taken by: Tom Filopoulos Date:

Certificate
of
Insurance
on file: Expiry Date:
Verified by Security or Mall
Management

Check in
by: Date:
Dispatch
Officer
Acknowledgement of Security Requirements
1. Sign in with Security “PRIOR” upon start of your designated and approved start time.
Tenant’s name:
2. If your store has a rear access door that can be secured after all occupants have exited please
utilize this upon exiting
3. If your store does not have a rear access door or one that cannot be utilized, please use the
following designated mall entry/exit at:
4. Please try to have all your personnel exit the building at the same time.
5. No entry will be allowed after one hour of your designated START time (No Exceptions).