Date: ___________
Department: ___________________________________________________________________
Building: __________________________________________ Box Number_________________
Name of Building Coordinator or Manager:___________________________________________
We understand that person(s) in building after hours will be checked by University Police and must have either a current staff/faculty card or current Building Use Permit. Persons found without either can have any University keys confiscated and be escorted from the building.
We further understand that the purpose of the Building Use permit system is to increase the security of personnel and property. We will cooperate with the University Police in all actions involving Building Use permits.
Unless there is a change in the signatories or major areas of administrative control, this agreement is valid for three years.
Administrative Policy 13.3 covers Building Use Permits. (www.washington.edu/admin/rules/APS/13.03.html)
1. We issue Building Use Permits to: Students Grad. Students Staff Faculty
2. We do not issue Building Use Permits to students; none are after hours.
3. We do not issue Building Use Permits to staff/faculty since they have staff or faculty cards.
4. Our Building Use Permits are issued:
Quarterly to students.
Annually to students.
Annually to staff.
Annually to faculty.
Other specify: _____________________________________________________________
The following signatures are the only persons authorized to sign Building Use Permits for the Department.
1._______________________________________________________ (signature)
_______________________________________________________ (print or type Name/Title)
2. ______________________________________________________ (signature)
_______________________________________________________ (print or type Name/Title)
Return completed form to the University Police, Crime Prevention Unit, Box 355200. Please retain a copy for your records.
UW 1096 03/06