SAMPLE CHANGE ORDER - Centerton, Arkansas
CONSTRUCTION CHANGE ORDER FORM
Select a Name
To: ______________________
From: ____________________
Centerton Planning Project Coordinator
Individual to be contacted regarding this change.
Centerton Planning¡¯s Project # : _________________
Change Order # ________ Submittal # _______
Owner: ____________________________________
_______________________________________
Description of Change:
Project Name: _________________________________
Date Submitted: _____/_____/_____
Engineer:
Reason for Change:
Plan Sheets being Revised:
X_________________________________
Project Engineer
_______________
Date
Project Engineer is responsible for notifying the
Contractor of approval or denial of this Change
Order.
CITY STAFF USE ONLY:
?
Approved
Comments:
?
Denied
X
City Engineer
Date
Rev. 8/2/19
................
................
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