WORK PERMIT

CONTROL NUMBER: _________________________

11/13/21
DATE FILED: ________________________________
09260947903
CONTACT DETAILS: __________________________

TO : SM ADMINISTRATION OFFICE
FROM : CONTI’S BAKESHOP AND RESTAURANT

INSTRUCTION: Please check the box that applies and fill out all the details. Please attach all required documents for this
Work Permit to be processed.

TYPE OF WORK:
X Construction Renovation Operations

SCOPE:
Maintenance Repair X Installation Waterproofing Welding/Hot Works
X Carpentry Exhaust/Fresh Air X Electrical Plumbing Spray Painting
Masonry Aircon Gas Line Draining and Refilling Sanding
X Ingress X Egress X Delivery X Pullout

Remarks INSTALLATION OF PLATFORM, ELECTRICAL WORKS, PAINTING AND DELIVERY OF

MODULES.
Indicate reason if
the request is
emergency or
urgent

NOTES: For welding or hot works, please answer the Hot Work Permit Checklist.
Attach another sheet for the list of items/tools/equipment.

VALIDITY From To NAME OF CONTRACTOR: GERALD’S ADVERTISING

Date 11/15/21 11/21/21 NAMES OF PERSONNEL: (attach another sheet for additional names)
Time 8:00AM 11:00PM 1. 5.
2. 6.
LOCATION GROUND FLOOR 3. 7.
4. 8.

REQUESTED BY: TENANT’S OR CONTRACTOR’S AUTHORIZED SIGNATORY

GENER INGUA

Signature over printed name and designation

CONCURRED BY: APPROVED BY:

CRS EDD MALL OPERATIONS

FOR THE APPROVERS: Indicate the Personnel Posting needed.

Guard: Janitor: EMB:
From: From: From:
To: To: To:

Other requests: