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(Please print this page, fill out the form and return to the address below.)
Project Title: ______________________________ Location: ________________________________
Requestor:__________________ Phone:________ Facilities Lead: _____________ Phone: ________
Project Justification/Scope (attach additional sheets if necessary):
Scope/Budge Estimate Does Not Include:
Facilities Manager Support: Yes No, because _________________________________________
Budgetary Estimate:
Materials: $____________ = %______ Basis: __________________________________
Labor: $____________ = %______ Basis: __________________________________
Project Total: $____________ Estimated by: ____________________ Date: ___________
Department Dean or VP Acceptance: (acceptance implies project will be forwarded for prioritization & scheduling)
Scope & Budget Acceptance:
_____________________________________ _____________________ _______________ (Name) (Title) (Date)
Please list any special schedule or fiscal considerations:
Return to: Facilities Design & Construction, 165 Wilber Hall
For Facilities Use Only: Initial Approach: LMI LMA MLS MRH CLA CLH CCF CDA Other________
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