REQUEST FOR FACILITIES RENOVATION PROJECT
PROJECT REQUESTOR
PHONE
EXTENSION
PROJECT REQUESTOR
SUPERVISOR
PROJECT LOCATION - BUILDING & ROOM # DEPARTMENT
IS THIS SPACE CURRENTLY ASSIGNED TO YOUR DEPARTMENT?
YES
NO
SCOPE OF RENOVATION WORK TO INCLUDE (SELECT ALL ITEMS THAT APPLY)
EXPANSION OF EXISTING SPACE
NEW WALL/DOOR/ WINDOW
CONSTRUCTION
ADD / REMOVE PLUMBING
CEILING REPLACEMENT
NEW OR REPLACE LIGHTING
NEW FLOORING
PAINTING
NEW ELECTRICAL OR DATA
AV / PROJECTORS OR LCD
SCREENS
EQUIPMENT OR TECHNOLOGY
NEW FURNITURE
OTHER
DEFINE THE SCOPE OF THE PROJECT
PLEASE PROVIDE A BRIEF OVERVIEW OF THE PROJECT, EXPLAINING WHAT CONDITIONS
THE PROJECT WILL IMPROVE.
IS THERE A ROOM OR SPACE ON CAMPUS THIS NEW PROJECT SHOULD BE MODELED AFTER?
IN ORDER TO BETTER UNDERSTAND THE INTENT AND SCOPE OF THE PROJECT A SCOPING MEETING
WILL BE SCHEDULED. PLEASE LIST THE NAMES OF THOSE WHO SHOULD ATTEND THAT MEETING:
SOURCE OF PROJECT FUNDING
A PROJECT WILL NOT BE APPROVED WITHOUT A CONFIRMED SOURCE OF FUNDS.
MAXIMUM ALLOWABLE PROJECT BUDGET
SOURCE OF FUNDS
( LIST THE ACCOUNT NUMBER)
PLEASE INDICATE WHO HAS SIGNATURE AUTHORITY FOR THIS ACCOUNT
NOTE: THE SCHEDULE AND TIMING OF THE PROJECT WILL NOT BE CONFIRMED UNTIL THE SCOPE AND
FUNDING ARE FULLY APPROVED. THE SOURCE OF FUNDS NEEDS TO BE FULLY IDENTIFIED BEFORE THE
PROJECT WILL BE SCHEDULED.
PROJECT REQUESTOR SIGNATURE
DEAN OR VICE CHANCELLOR SIGNATURE
PLEASE RETURN ALL FORMS ELECTRONICALLY TO:
PNW Campus Planning and Project Management
cppm@pnw.edu
PLEASE USE THIS AREA FOR ANY ADDITIONAL INFORMATION